The young woman's foot odor is accompanied by physical findings on the plantar surfaces. What's your Dx? Rx?
Patient history: Over the past 4-6 months, patient has noticed "holes" on the soles of her feet. The malodor has become progressively worse.
Patient history: Patient describes mild discomfort, some foot pain upon weight bearing. Reports no trauma.
Physical examination: No callous formation found; no bruising, petechiae. Plantar surfaces are moist, malodorous.
Differential diagnosis: Basal cell nevus syndrome; circumscribed acral hypokeratosis; focal acral hyperkeratosis; keratolysis exfoliativa; tinea pedis; pitted keratolysis; plantar warts
Pitted keratolysis: Crateriform pitting on pressure-bearing aspects of plantar surface. Superficial cutaneous bacterial infection caused by
produces keratin-degrading enzymes. Odor related to production of sulfur compound byproducts.
Pitted keratolysis: Treatment. Keep feet dry; use topical aluminum chloride hexahydrate, erythromycin; clindamycin for 3-4 weeks.
Pitted keratolysis: Treatment. Acne medication off-label--combination of clindamycin and benzoyl peroxide.
A 17-year-old girl sees you after her mother threatens to fumigate the young woman's bedroom. The problem is foot odor that you can barely tolerate when you enter the exam room. There are physical clues to the underlying problem as well as the pungent air. Follow the case in the slides above.What's in your differential? Your diagnosis?Â Â
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