A 21-year-old previously healthy male went to his college health center, reporting that he had injured his foot in Columbia while he was on winter break. Two weeks before this clinic visit, he felt a “scrape” on the bottom of his foot while walking on the beach. One week later, the site began to itch and was progressively enlarging. He had no systemic symptoms and no pain at the site. Physical examination showed a 3-cm-wide indurated filamentous/serpiginous eruption with surrounding erythema, and a crusting central “puncture” (FIGURE 1).
The patient seen immediately following the patient above was a 19-year-old female college student. For the last 1 to 2 weeks she had an enlarging, very pruritic eruption on the sole of her foot that she attributed to a bug bite. She had just returned from winter vacation in Brazil, where she recalled spending a lot of time on the beach. The patient was otherwise healthy and did not have fever, other rash, or joint pain. Examination revealed an indurated, erythematous, serpiginous eruption on the plantar aspect of her left foot (FIGURE 2).
FIGURE 1
Patient 1
FIGURE 2
Patient 2
What is your diagnosis for both cases?
How would you treat them, and advise for prevention of future similar problems?