Case of Dr P Barua 

A 31 yrs old house wife presented with lesion on her right foot. lesion started few years ago affecting both feet with itching. Visited several doctors treated with topical steroids and antifungal applications. She had been living with this lesion with temporary relief and recurrence since then. Not very complaint patient.
No present or past history of any major illness. No known Drug allergy. No Topical application for last one month. Mother asthmatic and diabetic.
She uses locally made rubber sandal.

O/E : Dry and scaly lesion -involving dorsum, plantar and web space between great toe and 2nd toe of the Right Foot with a bit lichenification on dorsum. No sign of inflammation. Mild discoloration on same position of left foot.

INVESTIGATION: Skin scrapping for KOH fungal microscopy found nothing . Advised for a Patch Test. She did not go for it!

C/D : Contact Dermatitis. D/D: Tinea Pedis.

Rx : Moisturizer, Betnovate CL Ointment (Betamethasone with clotrimazole mixed Ointment) with gradual dose reduction,Avoidance of sandal she wears.

F/Up? :After 14 days, over the phone she informed me -it is cured. However I advised her to continue moisturizer avoid the sandal.

Question : Was my C/D and Rx correct? Any suggestion?

The presence of the rash in a localised area around the first web space certainly suggests a rubber allergy but not much on the left foot yet. We have very few combination products of steroid and antifungal creams in Australia. What strength of Betamethasone is in your product?
Depending on what rubber molecule she was allergic to this lady may develope a dermatitis elsewhere she comes in contact with rubber eg elastic waistband etc.
If a tinea was considered you would have expected other web spaces to have been involved. The first web space is usually well aereated and less likely than say the 5th web space to have tinea. (Submitted By: Dr Ian McColl)