1. What essential question does one still need to ask to help make the diagnosis?
2. What is the tentative diagnosis?
3. Can you list at least three differential diagnoses?
4. What features of this condition differentiate it from other conditions in your differential?
5. What is the suitable treatment of this condition?
Treating A Patient With Blisters And Papules On The Soles
A 29-year-old Caucasian female patient presented in consultation in the foot and ankle clinic regarding a six-week history of erythematous vesicles and papules on the soles. She reported intense pruritus. Her primary care physician told her that she had a case of “athlete’s feet” and that she should use an over-the-counter (OTC) antifungal cream. After two weeks of treatment with antifungal cream, the patient had no improvement. The "www.consultant360.com>primary care physician then prescribed a first-generation cephalosporin but after two weeks, the condition became worse. The patient stated that she had no known exposures to any new chemicals, paints, toxins, irritants or other potential allergens. She was taking birth control pills but denied taking any other medications, vitamins or supplements. No one else in her household or within her family had any similar conditions.
What The Exam Revealed
Upon examination, the patient demonstrated small tense vesicular lesions and small papules on the lateral aspects of the digits of both feet and hands, and also on the plantar non-weightbearing surfaces of both feet. The vesicles did not involve the ankles or wrists, and there was little involvement of the dorsal acral surfaces. There were no targetoid lesions or other distinctive skin lesions. There were also no color changes or inflammation involving the eyes or ears. There were no tongue or oral lesions or discolorations. The patient’s vital signs were normal and there was no elevation of the oral temperature. The remaining portion of the physical examination was within normal limits and the patient had no other clinically significant skin conditions.