A 24-year-old man presented for evaluation of pruritic vesicles on both feet.
Ten days earlier, dyshidrotic eczema had been diagnosed by another physician
who prescribed triamcinolone ointment. The patient reported that the foot
eruption worsened after the topical medication was applied.
The suspected diagnosis of tinea pedis was confirmed by microscopic examination
of a potassium hydroxide preparation of material from the roof of a
blister. In some patients with tinea pedis, the eruption presents in an atypical
manner with blisters instead of the more common erythematous scaling patches.
Anti-inflammatory agents dampen the immune response and exacerbate
The patient was told to immediately discontinue the corticosteroid, which
was replaced with a topical antifungal agent. After 3 weeks of twice-daily application,
the fungal infection completely resolved.