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After completing this case study, the reader should be able to:
Recognize the signs and symptoms of a dermatophyte infection.
Describe nonpharmacologic options for managing dermatophyte infection.
Recommend an appropriate treatment plan for a dermatophyte infection.
Explain the best way for the patient to use a selected antifungal product.
Dave Harvester is a 41-year-old man who presents to a family medicine clinic because of recent itching on 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.
Appendectomy 20 years ago
GERD diagnosed 5 years ago
Type 2 diabetes mellitus diagnosed 1 year ago
Dyslipidemia diagnosed 1 year ago
Recent sexual activity (within past month); denies tobacco use; drinks beer on weekends and after games or practice
Metformin 500 mg twice daily
Penicillin (rash as a baby)
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.
An obese, but healthy-looking man wearing sandals, shorts, and a T-shirt. Oriented × 3, normal mood and affect.
BP 118/78 mm Hg, P 60 bpm, RR 18; Wt 105 kg, Ht 5′11″
Visible regions are soft and moist.
Normocephalic, PERLA, EOMI, external auditory canals and tympanic membranes clear, hearing grossly; no nasal discharge; oral cavity and pharynx normal, no inflammation, swelling, or lesions