Diagnosis and treatment of moccasin-type/hyperkeratotic tinea pedis
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CASE: A man in his 70s was referred to infectious diseases for evaluation of a clinically unresponsive fungal infection. Eight months ago, the patient noticed bilateral erythematous papules and patches on both feet with associated desquamation that worsened over time. His past medical history was non-contributory. Previous treatments included topical ciclopirox, oral fluconazole, oral terbinafine, and a combination of oral terbinafine and topical ciclopirox with no clinical improvement. Itraconazole had been prescribed by his dermatologist: 200mg twice daily for seven days, three weeks off, followed by a repeat course for seven days. The patient noted some improvement but after discontinuation the skin lesions recurred. At this point, the patient was referred to infectious disease, where itraconazole was reinitiated at 300mg twice daily for 6 weeks with resolution of the lesions.
Am j Hosp Med 2021 Dec;5(4):2021.
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