What Type of Rash Might This Be?

I started last August, 2001 with an approximately quarter-sized itchy rash on the top of my left foot.  By January of 2002, a similar itchy area appeared on the top of my right foot.  I started using Lamisil in February, thinking it might be a fungal infection.  In May, after one day in the sun, both my feet,  tops only, from the bottom of the toes to the ankles, were broken out in a red, bumpy, very itchy rash, which I could not help scratching.  My feet were swollen and the skin was cracking badly.  I didn't know if the reaction was to the Lamisil, or the sun, or a combination, or was a spreading of the infection.  I went to a podiatrist, who diagnosed an allergic reaction to the dyes in my shoes.  This made sense because the shoes were slide-on, open-toed, mules - and the leather covered the top portion of my feet. The podiatrist treated me with cortizone pills, (five days), and a bandage wrap, and Benadryl.  My skin peeled completely off and I threw out the shoes.  It is two weeks later.  The rash is back on my feet and has spread up the backs of my legs to the backs of my knees.  It is small, red or white in color, barely visible, extremely itchy and dries out in some places.  What should my next step be; what might the rash be?

[Alan Rockoff, MD]

Certainly not a fungus, or a reaction to Lamisil.

This sounds like an eczematous rash, quite possibly a contact dermatitis to the dye in the shoes, as the podiatrist suggested and quite properly treated you for.

My guess about the recurrence and worsening is that you are experiencing a rebound now that the cosrtiosne has been discontinued.

I would call back the podiatrist, or consult a dermatologist, about resuming cortisone by mouth for another 5-10 days.

Once the skin heals, allergy patch testing, which dermatologists do, may be useful to pinpint which chemicals you may be allergic to and want to avoid in the future.

Good luck.

Dr. Rockoff