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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the signs and symptoms of a dermatophyte infection.

  • Evaluate the risk factors for developing a dermatophyte infection.

  • Recommend an appropriate treatment plan for a dermatophyte infection.

  • Explain the best way for the patient to use a selected antifungal product.

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PATIENT PRESENTATION

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Chief Complaint

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“My feet itch.”

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HPI

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Dave Harvester is a 41-year-old man who presents to the local pharmacy because of recent itching in the area of his feet. He is an assistant manager at a local retail store who plays basketball at the YMCA for exercise three times a week. He sweats profusely during games and always showers before going home. He has not changed laundry detergent recently, but he admits that he does not always wash his athletic clothes between workouts. He says his feet have always smelled bad, but he first started to notice the burning and itching about 6 weeks ago. He started applying some deodorizing spray to his feet a week ago, but thus far it has only made a slight improvement in itching. Now his groin is starting to itch as well.

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PMH

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  • Appendectomy 20 years ago

  • GERD diagnosed 5 years ago

  • Type 2 diabetes mellitus diagnosed 1 year ago

  • High cholesterol diagnosed 1 year ago

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SH

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  • Recent sexual activity (within past month)

  • Denies tobacco use

  • Drinks beer on weekends and after games or practice

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Meds

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  • Pantoprazole 40 mg daily

  • Simvastatin 20 mg daily

  • Metformin 500 mg twice daily

  • Men’s multivitamin daily

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All

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Penicillin (rash as a baby)

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ROS

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Denies fever and chills. Fatigued, only after basketball practice. Reports frequent trauma to feet while playing in games. Complains of itching between his toes and groin area.

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Physical Examination (Limited)

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Gen
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An obese, but healthy-looking man wearing sandals, shorts, and a T-shirt

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VS
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BP 118/78 mm Hg, P 60 bpm, RR 18; Wt 105 kg, Ht 5′11″

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Skin
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Visible regions are soft and moist

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Abd
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Fat rolls can be seen around his belly

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Genit/Rect
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Not directly examined, but patient reports pruritus and burning of skin around groin, not on penis or scrotum. Redness can be seen on the medial aspects of the upper thighs.

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MS/Ext
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Foul-smelling, dry, scaling feet with white flaking between toes. Toenails on both feet appear to have yellow-brown discoloration. The nails of some of the toes are thicker ...

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