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Interesting Dermal Condition

Discussion in 'General Issues and Discussion Forum' started by björn, Nov 24, 2013.

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  1. björn

    björn Active Member


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    Hi,
    I had a 50 year old lady attend the clinic recently with an interesting dermal condition:
    Arch of right foot only, started after having been in SE asia about 1 year ago, but wearing thongs predominantly. Has never had this before.

    Symptoms - itchy and annoying so much that felt need for constant scratching - consequently making lesion worse.
    Has visited GP several times who has suggested numerous treatments
    Over counter anti-fungals useless.
    Tinasil 250mg oral terbinafine has not improved it. Experienced spots over body (a known side effects) so stopped.
    Doctor then recommended Eulactol Gold (!!!) whilst using resolve powder- and this was made dramatically worse.
    Now using Elocon .1% helps settle itchiness, and only mild effect on lesion size

    Further information I gathered was:
    Compliance with medicaments was excellent, footwear choices poor (still barefoot in high heeled shoes) and on feet for long periods. Would not normally suffer sweaty feet.

    No known medical conditions aside from elevated blood pressure, no "unwell symptoms" experienced when overseas and lesion was caused. Appears to get worse in warmer conditions.

    This looks to me almost like a really severe version of Pitted Keratolysis crossed with some sort of dermatophyte. I might be beyond my depth here, so said I'd check here, and likely refer onwards.

    If anyone can help me out on what they think it is, I'd greatly appreciate it. THanks. :)

    PS: the pics, this lady has approximately a Size 6 ladies foot size, but I guess the scale is not overly important in this case?
     

    Attached Files:

  2. dsfeet

    dsfeet Active Member

    Hi looks yukky!!!
    can't help with Dx but certainty don't think pitted kera ... seen some bad cases of this and doesn't resemble them at all
    could it be a parasite??? , a flesh eating one????
    good luck , keep us informed
     
  3. blinda

    blinda MVP

    This pt requires a swab to identify which pathogens are at play here. I doubt very much that there is dermatophyte infection.

    Bacterial skin infections, most often staph (which, if I was a gambling gal I would put my money on) or strep, occur frequently after bites and other trauma induced wounds in returned travelers from hotter climates, particularly the tropics.

    Bel
     
  4. W J Liggins

    W J Liggins Well-Known Member

    As herself said. You could always check with a Wood's light (if old fashioned) but first detailed history, then culture and sensitivity - I'd go with staph also until otherwise proved.

    Cheers

    Bill
     
  5. Ros Kidd

    Ros Kidd Active Member

    I would probably contact the National Mycology Centre, which is in Adelaide and talk to the HOD Dr Sarah Coad. Lovely lady, I think they have a web site with telephone numbers and contact information. This is right up their street.
    Ros
    P.S She is actually our daughter.
     
  6. björn

    björn Active Member

    Thanks for the replies. I saw this patient a few weeks ago now, and it took a while for me to gets pics uploaded. I'll give her a call to see if she's acted any further, and if not, suggest sampling by the GP.
     
  7. blinda

    blinda MVP

    Cool. Please let us know the outcome björn, so that we can all learn from this great case study. All too often we are presented with these interesting pics, etc never to find out what the diagnosis and tx was.

    Cheers,
    Bel
     
  8. Abel

    Abel Active Member

    Hi björn ,
    I am consulting in an dermatology Atlas ,but it is dificult contributing wiht some new , you should follow with this atypical case.
    We are all expectant.
     
  9. TerrySheehan

    TerrySheehan Member

    While I agree that initially it looks like a fungal infection the symptoms and appearance are almost identical to a severe case of psosiaris. I just looked on google images for severe psoriatic feet and the first image was almost a perfect match. The reason I say this is that I work for the NHS in England and I have also seen a few cases where the itching and the localised inflammation etc is almost identical and obviously if the cause is psoriasis the antifungal treatments wouldn't work. Hope this helps
     
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