Medical student who can't figure it out!

[extant010]

Hi! I'd definitely appreciate a second opinion in my case. Two months ago I noticed the onset of pruritis in the toes of my left foot, starting with the big toe and involving the others to a lesser degree, and then starting in my right toes two weeks later. I couldn't identify any specific lesions at any point. The pruritis was as much on the dorsal aspect of the toes as on the sides, and only occasionally on the underneath of the toes. There was an erythema mainly arising from the web spaces at times but this was not a consistent feature and may have been secondary to scratching. I do have sweaty feet. This pruritis has continued up to the present and my toes are more than a little excoriated by now. I should also point out that at the same time as the onset of the pruritis I developed two pruritic blisters on the sole of my foot with a serous fluid when burst. The flat area where those blisters were remains intermittently and acutely pruritic up to the present.

Anyway approximately a week ago I noticed the development of a raised, pruritic lesion on my right hand, index finger, lateral aspect. Over a day or so this developed into a 1x1cm area; raised, irregular to the touch, inermittently pruritic, and with multiple tiny vesicles with clear fluid evident throughout. Initially I would have described this as a well circumscribed lesion but now 4 days later I have approximately 6 areas on the fingers of my right hand that are raised with tiny (1-2mm vesicles) and they aren't well circumscribed. In some areas, especially in the centre of the digits, one or two vesicles can exist by themselves. There are no lesions on the dorsal surface of the digits, and the majority of the lesions are on the lateral aspects of my digits. The pulps are relatively clear. My nails and palms are not involved. So far my thumbs are not involved. The lateral aspect of my little finger on my left hand is involved but no other part of that hand. The pruritis isn't so bad with these lesions but they do irritate and it's more the worry of what they are.

Being a med student I have approached one or two graduated friends and I'm currently five days into a course of terbinafine orally (with appropriate monitoring of course), and I've being trying daktacort cream (miconazole+hydrocortisone 1%) on my hand lesions for the last three days. So far I haven't seen a major improvement with the oral meds in my feet or my hands and the daktacort seems if anything to make the lesions on the hands a bit more sensitive.

That mouthful of a history over - I'm wondering what the chances of this being a tinea are compared to a dihydrocytic ezcema, and if it is a tinea, am I covering it adequately with this therapy. When should I look for an improvement? Finally does this sound contagious via contact with others?

I have no other medical history and am on no other medications. Nothing of note in the rest of my history. This is all new.

Thank you for your patience!

[Alan Rockoff, MD]

Sounds like dyshidrotic eczema, not fungus, because fungus isn't usually that vesicular (blistery).  Much of the redness may indeed be from scratching.  Daktacort (1% hydrocortisone) is too weak to affect thick-skinned areas like the hands and feet.  When dyshidrosis is symptomatic, you need stronger preparations, which you should seek out from a doctor who knows about skin and takes a look at you.



Dyshidrotic eczema is not contagious.



Also, it's spelled, "pruritus."



Take care.



Dr. Rockoff

[extant010]

Thanks much appreciated! Will post how it turns out. Great service!

[extant010]

Just to say I saw a dermatogist and she agrees with the diagnosis, I'll start proper strength steroid medication and hope it resolves permanently!