It’s somewhat unusual to see a patient with an eight-year history of the same problem, but this is what happens when a 51-year-old man presents to dermatology. Specifically, the problem is a very itchy foot rash, for which the patient has tried many OTC products without success. He has also used halobetasol cream, prescribed by a dermatologist he saw several years ago.
The patient denies having a rash anywhere else. He does, however, have a markedly atopic history, significant for seasonal allergies, asthma, and very sensitive skin.
For the past several years, when the rash has been particularly unbearable, he admits to pouring rubbing alcohol on his feet. This burned terribly, but his feet felt better afterward.
Asked what else happened eight years ago, the patient recalls starting his current job as a lineman for a power company—an occupation that requires him to wear steel-toed leather boots for hours at a time.
EXAMINATION
A dense, red, papulovesicular rash covers both feet in a stocking pattern. The rash stops abruptly at the same place on both lower legs, completely sparing the soles and interdigital skin. Focal areas of scaling and broken skin are seen on the tops and sides of both feet.
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