Scrape before you script

This lady was treated for suspected tinea pedis because of the red scaly rash in the first web spaces of both feet. No skin scraping was done but she was given numerous topical antifungal creams and then oral terbinafine. Sometimes the rash improved, but never cleared. She wore occlusive jogging shoes most of the time but at home she would wear rubber thongs to let her skin ‘breathe’. The diagnosis was rubber contact allergy from the thongs. Most fungal web space infections are in the third and fourth web spaces because these are the most occluded and damp. It is important to take skin scrapings of suspected tinea before prescribing systemic therapy. Her patch tests can be viewed at