What caused this vesicular, draining eruption?

This itchy and tender vesicular, draining rash first erupted on the feet of a 24-year-old man a few weeks earlier. Medicated salt soaks have been ineffective. The patient’s job requires that he wear work boots; he has not bought a new pair recently.

Do you recognize the disorder(s)?

A. Contact dermatitis.

B. Tinea pedis.

C. Dyshidrosis.

D. Bullous impetigo.

E. Hyperhidrosis.

(Answer on next page.)

          ANSWER— Tinea pedis with dyshidrosis          

This patient has extensive tinea pedis, B, and secondary dyshidrosis, C, with vesiculation. A KOH evaluation and bacterial culture can confirm the diagnsosis.

Because of the widespread involvement, systemic therapy is preferable to topical treatment. Systemic antifungal medication with a short, tapering course of prednisone provided prompt and sustained relief. The patient was advised to buy new work boots and to treat the old pair with antifungal spray and powder or discard them to prevent reinfection.