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For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.
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What is the condition affecting the foot?
This is tinea pedis, a presentation known as "moccasin" tinea because it encases the foot like a moccasin slipper. The responsible dermatophyte fungus is nearly always Trichophyton rubrum. As moccasin tinea is relatively asymptomatic, patients frequently present when a dermatophyte infection develops at another body site such as toenails or the groin.
How would you confirm the diagnosis?
Because foot eczema and psoriasis can resemble moccasin tinea, the diagnosis should always be confirmed by scraping the affected skin for microscopy using potassium hydroxide and fungal culture. Swabs should also be taken in case of bacterial or yeast infection.
How would you treat it?
Treatment will depend on the extent of the dermatophyte infection. Moccasin tinea may be resistant to topical antifungal agents, but these should be recommended initially for a period of several weeks. Most cases will require oral treatment, either terbinafine 250 mg daily or oral itraconazole 200mg twice daily for 7 to 30 days. Longer courses are necessary if the patient also has onychomycosis. Prophylaxis or repeated courses may be necessary as moccasin tinea frequently relapses.
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