when is a fungal heel blister not a fungal heel blister

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Hi , I saw a patient yesterday who has been suffering from chronic blisters on both heels (Right then Left )for more than 6 months now .
This is a lady who is large and has a number of eczema type skin issues . which have been causing her problems for a bout 3 years.
She has skin plaques on the tips of both second toes under the nail these are shiny and planar , to me they look psoriatic. she has had fingernail problems and toe nail dystrophy.
She has had test for fungal infections done by a couple of dermatologists and all results have been negative .
The blisters on her heels are biomechanical in nature at least partly , as there seems to be a plaque of callus in the centre of the blister which is the initial cause .

but this does not explain the size and type of blister and the time it takes to heal.
My thoughts are auto immune or Psoriasis , as underlying conditions .
thoughts and ideas would be greatly appreciated on to what could be the underlying cause.
Initially I am only treating the blisters but would like to get an idea of what is going on ....
the Dermatologists she has seen were more involved in cosmetic treatments .....

 

There are many systemic and environmental factors that can create acral hyperkeratosis and/or blistering. Could you please provide a more detailed medical, familial, occupational and social history? What allergies does she have? What is her age? Footwear like? Do the blisters/callus hurt? Are the blisters always present, or does she have periods with no callus or blistering? What treatments has she tried? What was the diagnosis of the dermatologists? And...do you have a photo of the lesions? It is very difficult to provide derm advice without.

Cheers,
Bel

 

hi thanks for your reply
teacher age 50 , overweight has had a 3 year history of " eczema"
has been tested for lupus , HIV fungal infection , were the 3 things she mentioned . Has potential allergy to Latex
she was unable to remember the other conditions tested ., she is bringing her records next week. I believe there may be a fairly complex history
She was diagnosed with Tinea by one dermatologist and Atypical eczema by another.
pics to follow