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Weird interdigital lesion

Discussion in 'General Issues and Discussion Forum' started by pamelachen, May 17, 2010.

  1. pamelachen

    pamelachen Member

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    hi everyone...

    i saw a healthy, non-diabetic patient today with an odd-looking interdigital lesion - approximately 2cmX2cm in the 4/5th interspace. present for approximately one and a half years, regressing and recurring very slightly with heavy militant use of topical and oral antifungals. no pain or itching is associated with the lesion. patient has had 2 cultures/clippings taken from the lesion - both were negative for fungal infections. heaps of macerated callus was present, kinda like in a diabetic neuropathic ulcer - which was debrided, and skin underlying was healthy and not broken. the lesion is very isolated, with no signs of spreading to the surrounding skin or toenails (if its fungal, which heaps of people/doctors assumed it was)
    could anyone offer any interesting alternatives to fungal infection or soft corn? many thanks
  2. Hi Pamelachen :welcome: to Podiatry Arena.

    Sounds like a Soft corn but really you will get some better and more specific advice if you post a couple pictures as they say picture tells a 1000 words.

    to do this go advanced in your post
    scrole down hit the manage attachments button and follow the instructions and you can upload pictures for people to look at.

  3. David Smith

    David Smith Well-Known Member


    Sounds like a corn HD or HM I have often had patients who have treated or been diagnosed as tinea pedis but were actually corns, usually the ones that are right deep in the web rather than on the side of the toe. Do you really Mean 2cm x 2cm, thats 3/4"x3/4", which is well bigger than the intergigital space unless they have size 18 feet

    Aah the intergigital space, Giggidy! :D[​IMG]

    Cheers Dave
  4. blinda

    blinda MVP

    I tend to agree with Mike and Dave, HD, HM or TP - common things occur commonly and all that.

    Diff Dx - I have seen an eccrine poroma in an ID space before, does it bleed when debrided? Also, histopathology would reveal the characteristic proliferation of eccrine ducts.

    Other, not so usual, Diff Dx - HPV, pyogenic granuloma, intradermal nevus.

    A pic would be grand.

  5. pamelachen

    pamelachen Member


    thanks for all the replies :), no i didnt manage to get a picture :(
    it was 2cm by 2cm i reckon, it extended up the sides of the toes, kinda to around the PIPJ area? was hard to debride but didnt bleed - i half thought it would but it was just really really macerated...
    many thanks :)
  6. blinda

    blinda MVP

    Hi Pam,

    If in doubt, refer on for biopsy. I have seen one case of Bowens disease which presented ID and mimicked T/P.

    Let us know the outcome.

  7. Trudi

    Trudi Member

    If present for that long, and never really healing well, you do need to refer for a biopsy. Remember feet are a very common site for cancers. I am only part-time, yet I generally see a cancer on the feet, toes and under nails about 1 in every 3yrs. Hope not for the patient's sake, but needs to be ruled out.

  8. nigelroberts

    nigelroberts Active Member

    Remember feet are a very common site for cancers.................I generally see a cancer on the feet, toes and under nails about 1 in every 3yrs.

    Is that really common?
  9. Fraoch

    Fraoch Active Member

    Are they coming in again soon? What did you recommend to get the area dried up? I'm with Blinda, my first thought was Bowens. Also agree with the others; strange things need to be biopsied.
    Two years ago I had a guy with a useless GP. Long story short I had to send him to another city to get his toe operated. THe ulcer healed, then we spotted black tissue. Again the GP argued with me about necrosis or silver staining. PT died 6/12 later from a rare skin cancer. Many of my pts do not take their skin lesions seriously; refuse biopsies and referrals to Dermatology.
  10. Trudi

    Trudi Member

    Hi Nigel...well being in Australia, unfortunately we do get alot of skin cancers. Considering people wear sandals and thongs, it ups the odds of getting skin cancers on the feet. Most White Australians do not have the skin quality for the amount of gorgeous sunshine we receive. Then...remember tourists all over the world love to run to other countries and sun bathe ( or cook themselves for a week or two ) and who ever remembers to put sunscreen on their feet.
  11. drsarbes

    drsarbes Well-Known Member

    If you would like some opinions that actually may help, it would be advantageous to perhaps describe the pathology in question in a clinical manner.
    I have reread your original post and I still know nothing of this lesion other than it's apparent size and the fact that it is macerated.

    If you are unaware of how to describe a lesion, here is some quick advice:
    size, color, borders, elevation, surrounding tissue, location.
    also helpful: duration, symptoms, previous treatment.

    Negative historical connotations are not as helpful as positive ones. For instance, unless you state that the person is a diabetic, one can assume that they are not.

    Hope this helps.

  12. pamelachen

    pamelachen Member


    thanks for all your replies..
    the patient didnt require any medical referral as he is a health professional himself...

    steve - thanks for the advice :)
    let me try re-describing the lesion: 2cmX2cm, extending up the medial and lateral sides of the 5th and 4th toes respectively, white-coloured with well demarcated margins, non-elevated and normal skin surrounding the lesion. lesion had been present for about 18months to 2 years, treated on and off with oral and topical antifungals (about 2 months oral and 15 months of topical?), which managed to achieve a slight decrease in size of the lesion but never led to total resolution. no symptoms (pain/itching), or signs of infection present...

    i advised him to continue with the antifungals and he told me he would get himself an appointment with a dermatologist or ID specialist...

  13. drsarbes

    drsarbes Well-Known Member

    My best guess - typical heloma molle.


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