Pictorial case study: Fungal infection of the sole

A 50-year-old man presented with non itchy but sweaty feet and areas of moist red skin between his toes.

His toe nails were creamy yellow and craggy. He complained of itching and burning between the toes. A few small blisters had appeared on his toes. The scales were fine and accentuated in crease lines. What is the diagnosis, management and differential diagnosis?

Diagnosis and management

The diagnosis is fungal infection of the sole. Antifungal creams would have helped his skin, but his toes need to be treated with oral antifungal agents.

Possible different diagnoses

  • Chronic psoriasis.
  • Chronic dermatitis.
  • Tylosis.
  • Pitted keratolysis.

Differential diagnosis

Chronic psoriasis:

  • Usually affects adults but can present at any age.
  • Affects both sexes.
  • There is usually a positive family history.
  • There may be psoriatic patches in other sites.
  • Red patches with pustules.
  • The condition is painful rather than itchy.
  • Clear line of demarcation.
  • Nail pitting and arthritis may be present.
  • Grooved or umbilicated hyperkeratotic ridges.

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