Why do dermatologists love these cumbersome terms??
The patient is a 30 yo woman with a two week history of a sore area between the 3rd and 4th toes of the left foot. She is in good general health. Not pregnant and on no oral contraceptives. Both parents have Type II diabetes. At the time of onset she was on doxycycline for rosacea.
The examination shows an erosion in the toe web. The KOH prep was positive for pseudohyphae consistent with the diagnosis of erosio interdigitalis blastomycetica
Given her family history she should be worked up for diabetes. The doxycycline may have also played a role.
The role of maceration was discussed. She will keep toes separated and use ketoconazole cream. If this in not effective, I will ask her to dry area after bathing with a hair dryer and continue an imidazole cream or solution.
This is from emedicine.com:
Intertrigo: Intertrigo typically presents with erythema, cracking, and maceration with soreness and pruritic symptoms. Lesions typically have an irregular margin with surrounding satellite papules and pustules. Web spaces of affected fingers or toes are macerated and have the appearance of soft white skin, which is a condition termed erosio interdigitalis blastomycetica (interdigital candidosis).
A good source for the treatment of intertrigo is at: http://www.emedicine.com/derm/topic198.htm
This type of intertrigo is so common among Iraqi housewives ,both in the fingers and toes webs.The main cause is wetness during heavy house work.I believe candida albicans is the main pathological cause and not dermatophytes even in so called tinea pedis among housewives as proved by unpublished study.
ReplyDeleteManagement is to stop wetness plus antimonelial and bacterial creams
khalifa sharquie