A 22-year-old man came to the office with feet that were malodorous, had a rash, and were sweaty. The odor is made worse by any exercise that leads to a lot of foot sweating. His friends and family complain when he removes his shoes. He reported that everyone once left a public locker room after he removed his shoes. He is so embarrassed by this problem that he has waited months before seeking help.
The young man admits to wearing shoes that don’t let his feet breathe well, but he finds these to be the most comfortable shoes he has. He doesn’t like that his socks get wet easily from his excessive sweating. Aside from the malodor and hyperhidrosis of the feet, he denies any pain or severe pruritus.
On examination, the foul odor was immediately apparent. Multiple cribriform pits were noted on the pressure-bearing areas of the soles (FIGURE). There was scaling of the skin on the soles and around the toes. There was no lymphadenopathy. No other skin or mucosal areas involvements. His family history and review of systems were unremarkable.
FIGURE
Multiple pits on the sole
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