How to diagnose and treat tinea

Case presentation

A 34-year-old man presented with an itchy rash on his feet of 14 months’ duration. He was vague about the history but thought it had started on the sole of the left foot, then spread to the sole of the right foot a few months later. He had tried over-the-counter topical antifungal creams and a hydrocortisone cream with marginal benefit.

The rash had moved on to his right hand a few months before presentation. During this time the rash had spread over the feet to involve the whole of the soles (including the insteps) and part of the sides of the feet (Figures 1a and b). On the hand it had spread from the distal palm and fingers to also involve the sides and back of the hand (Figure 1c). The patient only sought treatment from his GP after the rash started on his hand.