During a holiday in regional NSW, a middle-aged woman develops an unusual skin condition characterised by two crusted papules on her right foot. 

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<p>During a holiday in regional NSW, a middle-aged woman develops an unusual skin condition characterised by two crusted papules on her right foot.</p><p>She discovers the lesions an hour after walking around bushland. At the time, she also notices blood on her shoe.</p><p>The lesions have now been present for a week. They are associated with persistent itching and are exacerbated by touch or exposure to hot water.</p><p>The patient seeks medical advice to identify the cause and potential risks associated with these lesions, considering the peculiar circumstances and geographical location in which they developed.</p>

Professor Dedee Murrell is head of dermatology at St George Hospital and conjoint professor at UNSW Sydney.