​  ​中環鍾經略醫生【皮膚學碩士 x 美容醫學碩士】(課程研究)

This is a case of fungal infection of both feet also known as tinea pedis.

This is a 55 year old gentleman who complained of mild itchiness of both of his feet for a few months.

Physical examination:

PE showed 2 types of clinical manifestations of tinea pedis – interdigital type and moccasin type ( the other two types include: inflammatory/bullous type and ulcerative type)

Interdigital type:

The skin of the webspace between the 4th and 5th toes is hyperkeratotic and macerated (which is due to the hydration of the stratum corneum).

(Note: KOH+ preparation will show septated hyphae and confirm the diagnosis. Erythrasma can occur concomitantly, which can be ruled out by wood lamp examination – negative coral red fluorescence. Pseudomonas aeruginosa may sometimes isolated on bacterial culture)

Moccasin type:

relatively well demarcated erythematous (in this case brownish post inflammatory hyperpigmentation) patches of rash with fine white scaling, and hyperkeratosis. Mainly on the lateral borders of feet, but can also occur on heels and soles.

Etiology:

For moist (macerated) type of interdigital tinea pedis – T. rubrum, T mentagrohytes

For dry type of interdigital tinea pedis – T. rubrum

For moccasin type – T. rubrum, Epidermophyton floccosum

For inflammatory or bullous (vesiclar) type – T. mentagrophytes var. mentagrophytes

For For ulcerative type – T. rubrum, E floccosum, T. mentagrophytes, C. albicans

Management:

Topical Ketoconazole cream and oral Itraconazole 200 mg daily for 14 days.

本文之中文翻譯本,如與原文有差異,應以英文版本為準。

這是雙足真菌感染 ( 足癬) 的病例.

患者男性,55歲,雙足輕度痕癢數月.

【臨床檢查】

臨床檢查發現同一患者同時表現足癬兩個同的臨床型 : " 趾間型 " (圖1 & 圖2) 和 " 拖鞋型 “(圖3 & 圖4). (足癬其他兩個型包括: " 炎性 / 水疱型 " 和 " 潰瘍型 " )

【趾間型】上圖第4/5趾間之趾蹼的皮膚過度角化和被浸漬現像(由於中央部份水化作用所致)

(註: KOH+標本可發現菌絲而確定診斷; 紅癬可能並存,後者可以用wood lamp examination加以排除 – 其珊瑚紅螢光呈陰性; 細菌培飬有時可能分離出綠膿杆菌.)

【拖鞋型】邊界頗清晰的紅斑(本例呈褐色是因為炎症後導致色素加深) 伴有幼細白色脫屑, 以及過度角化. 病变主要在足側緣, 但也可發生在足跟和足底.

【病原体】

濕性趾間(浸漬)型足癬: 紅色髮癬菌, 鬚髮癬菌.

乾性趾間型足癬: 紅色髮癬菌

拖鞋型: 紅色髮癬菌,絮狀表皮癬菌.

炎性 / 水疱型: 鬚髮癬菌.

潰瘍型: 紅色髮癬菌,絮狀表皮癬菌,鬚髮癬菌,白色念珠菌.

【治療】

外用 Ketoconazole cream 及 每日口服 Itraconazole 200mg 共14天.

主診醫生:鍾經略醫生

監督及指導機構 – 英國威爾斯大學/卡的夫大學臨床皮膚科專科部門

臨床皮膚科醫學照片版權所有,不得複製

皮膚科醫生常見皮膚問題 – 香港腳