Dr. Subhash Kashyap
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am having an allergic reaction on both of my feet. It will start like fluid-filled vesicle, then it will get hardened and will start peeling off the skin. There is an excess of itching in that affected area. I had consulted a dermatologist and was told that it is contact dermatitis. Doctor prescribed me Momate-F ointment for two weeks and asked me to change the footwear. It did not subside after two weeks and then the doctor prescribed Halovate-F ointment and Levocetirizine for two weeks. Then also it is not subsiding. It has been more than two months and still, eczema is present and new areas on my foot are getting affected.
Hi,
Welcome to icliniq.com.
Very itchy rash over the feet with fluid-filled vesicular lesions is tinea pedis vesicular type. No response to steroids also confirms that. Contact dermatitis also mimics it and bilateral also gives suspicion of dermatitis but you did not respond to steroids. I can see some involvement of toe clefts. Please tell me are clefts involved? How much duration since the start? How it started, like which area and which foot? Do you buy any new shoes, or anything new when they started? Do you have wet work of feet often? Any other medical condition you have like DM, BP, etc., renal or liver disease? Start the following treatment. Capsule Itraconazole 200 mg bd after meals for three weeks, Terbinafine cream twice daily for three weeks, Loratadine 10 mg once daily for itching for 10 days, KZ dusting powder. Avoid wetting or sweating of feet. Keep dry. Dry shoes in sun. Change socks daily.
The Probable causes
Differential diagnosis
Treatment plan
Preventive measures
Regarding follow up
Patient's Query
Thank you doctor,
The toe cleft came after starting the lesions. It started before two months. Initially, it started at three sites, one below the toenail of right foot, next, at the side of the left foot and another in between little finger and fourth finger of the right foot. At that time I was not wearing any new footwear. Also, I do not have any other medical condition. The itching is not too much during day time it is more at night. I did not have any wet work of feet. I am attaching the images of lesions when it was started.
Hi,
Welcome back to icliniq.com.
Please continue the treatment I advised. It is fungal only. Allergic will occur at the site of contact only. Cleft involvement confirms it to be fungal. It will take three weeks or more to heal completely.
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