“I have an itchy rash on my stomach and feet that won’t go away.”
History of Present Illness
RP is a 16-year-old male who presents to his primary care provider’s clinic at his mother’s insistence because of a persistent pruritic rash on his trunk and feet. He is a high school sophomore and a member of the wrestling team. He reports having two areas on his trunk that are circular, red, and itchy. He says they have increased in size since he first noticed them about 3 weeks ago. He says his feet have always smelled bad, but he first started to notice redness and “extreme itching” between his toes on both feet about 2 weeks ago. He has used over-the-counter hydrocortisone cream on the rash on his trunk without improvement. He also started applying deodorizing spray to his feet a week ago without improvement.
Seasonal allergies; asthma as a young child (asymptomatic for 10 years)
Father has diabetes, diagnosed at age 45; mother has HTN, diagnosed at age 38; both parents are living
Lives at home with parents and elder sister; denies tobacco, alcohol, and illegal drug use
Loratadine 10 mg PO daily
Occasional ibuprofen for muscle pain/sports injuries
BP 118/78 mm Hg, P 60, RR 18 breaths per minute, Ht 5′11″, Wt 82 kg
Healthy-looking teenager, muscular build, well-developed, well-nourished, in NAD
Normocephalic, atraumatic, PERRLA, EOMI, moist mucous membranes
Normal breath sounds, no crackles or wheezes
Soft, non-distended, non-tender, normal bowel sounds
Normal male genitalia without erythema or scaling
Two round, erythematous, and scaly areas visible on the trunk; each measures about 1 to 2 inches in diameter; each with a well demarcated, raised border and area of central clearing
Foul-smelling, dry, scaling feet with localized redness and white flaking between the toes. Toenails on both feet appear normal and without discoloration.