EMPD presents with a slowly expanding, moist, red, raised rash with a sharp border between normal and involved skin. There may be scattered areas of white scale and erosion, which is often described as “strawberries and cream” appearance. There may be associated itch, bleeding or burning sensation. The vulva in women and the perianal region in men are the most commonly affected areas. Other sites on which EMPD may occur on include the scrotum, penis, perineum and armpits. In patients with secondary EMPD, they may present with findings of an underlying cancer, such as a swollen lymph node.