Itchy blisters

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Any thoughts guys

Blisters began appearing on both feet in the early nineteen eighties.
Covered a specific area. Plantar aspect B/F, between toes, under the ankles and around the edges of the feet ( moccasin type Tinea ??). Never on the top of the foot and never on the same site.

At this time the pt had swabs taken for culture and sensitivety and skin scrapings for mycology. Results showed secondary infection which was treated with erythromycin with desired results. This reoccurred over a period of approx. 3 years when the episodes became less severe.

The foot becomes extremely itchy with some burning and pain. The only relief she gets is to break the blister and remove the fluid.
Several creams have been tried to alleviate the condition, cortisone type creams, antifungal creams and powders, over the counter creams.
Different footwear and socks have also been tried with no satisfactory result.

pt has noticed a difference in the severity of the condition since she ceased to wear nylon hosiery.

Heat always exacerbates the condition and cool compress assists in alleviating the itchiness. In bad breakouts the itchiness is accompanied by stinging and pain.

The outbreaks are now mainly on the right foot with small outbreaks only on the left, periodically just the odd single blister.
She has been referred to a dermatologist on several occasions but at each appointment attended there was no blister present.

In 1992 She had a laminectomy at C4/5. In 1996 she was diagnosed with fybromyalgia, which gives her constant pain and discomfort and at times can make her house bound. She also have haemachromatosis, diagnosed in 2003 and has regular venesections.

clinically obese suffer from hypertension and elevated cholesterol.

Medications - monoplus
Asterix
Cholstat

She takes a magnesium supplement daily. Panadol or Aspro clear for pain. (she has a sensitivity to Opiates) and have developed a allergy to elastoplasts.

Surgical hx
cholecystectomy
Hysterectomy
Tonsils
Arthroscopy left knee
Carpal tunnel – right hand
Laminectomy C4/5
Iron levels - vary,

Hb – in 150- 160 range, LFTS, cholesterol, glucose, FBE all in acceptable range.

I have referred to dermatology, waiting list 4 months.

1st thoughts mechanical stress Evcessive pronation, ↑ BMI, ↑ perspirarion all contributing factors. Itchyness ? tingling ? Pain?.

Some pics below.

pt is a work colleague.

 

Hi
Just wondered if you had eliminated pustular psoriasis?
Wendy

 

Hi Wendy.

Yes, thought of that as well. been ruled out by several G.Ps.

Came accross Erythema Multiforme while searching the web and looking for info.

have a look, let me know what you think!! think i'll leave it to the experts.

http://www.patient.co.uk/showdoc/40001002/

thanks for the interest

 

Hi Brian,

looks fungal to me.

(Dry, itchy, fluid blisters, inflammation, made worse with nylon hosiery & warmth, eased by cool applications).

I would have thought steroid creams would make the matter worse so not something I would recommend.

If an inadequate sample was taken then lab tests for fungal infn. may be inconclusive.

Are areas restricted to sites of shearing?

Pts. skin appears very dry so shearing could provoke further irritation which may be footwear related.

If the pt. is obese then ability to maintain adequate foot hygeine may be an issue & also pt. may be unlikely to comply with advised application of medicaments.

Is she undergoing any further investigations? Dermatology etc?

Interested to know what happens.

Regards & Mon the Hoops

 

Hi twirly,

I personally think its mechanical in origin. With other contributing factors.

4 month wait for Dermatology appointment. Closed fitting can cause further irritation but not always. These blisters seem to appear periodically with no set pattern. It was the burning pain that concerned me, even when not weight bearing.

Pt is a work collegue twirly was looking for a quick fix to the pain she experiences.

Looks for a job for the Derm boys.

 

Hi Brian,

Did you arrive at any conclusion with this pt? I`d be interested to hear what the derm team diagnosis was.

Cheers,
Bel

 

Just an outside idea, what about atypical idiopathic dermatatis? I get a similar presentation on the back of my right hand, have had for years, comes and goes at it's own whim, ruled out fungal, contact dermatitis, allergies etc. the onlythng that seems to occasionally fit a patten is changes of weather, or when i'm stressed?
With management, Im finding icthamol cream to be great in keeping the itching and burning down?
Worth a try?
Cheers!

 

There's some pitting at each blister site...are they discrete individual small pus / yellow hemispheres before they burst?

 

Derm diagnosis, Bacillus.

Treatment started

3 months no change

 

I wiil let her know about the Icthamol