Giving a Rash the Boot
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Joe R. Monroe, MPAS, PA, practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Physician Assistants.

A warehouse worker has had the itchy rash on his foot for years. Has his company-mandated footwear played a role in this discomfort?

Question 1 of 1

For many years, a 49-year-old man has had an itchy rash on his right foot. It waxes and wanes with the seasons: worse during hot weather, better in the winter. He works in a hot warehouse where the dress code requires him to wear 9-inch boots.

The patient has treated the rash with many topical products, including clotrimazole, tolnaftate creams, and various powders. He has found that topical 1% hydrocortisone works best for relieving the itch.

On examination, there is redness, maceration, and mild edema in the webspace between the 4th and 5th toes, spilling onto the plantar forefoot in that area. KOH examination of scrapings from the affected area shows abundant fungal elements (hyphae).

Based on the exam, what correctly explains this patient’s rash?

He has a treatment-resistant fungal infection (tinea pedis).

His infection is bacterial, not fungal.

His problem is chronic and might be controllable but not curable.

His fungal infection is perpetuated by wearing black socks.

Clinician Reviews. 2019 November;29(11):1e-2e

This quiz is not accredited for CME.

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