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LEARNING OBJECTIVES

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.

PATIENT PRESENTATION

Chief Complaint

“My feet itch.”

HPI

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.

PMH

Appendectomy 20 years ago

GERD diagnosed 5 years ago

Type 2 diabetes mellitus diagnosed 1 year ago

Dyslipidemia diagnosed 1 year ago

SH

Recent sexual activity (within past month); denies tobacco use; drinks beer on weekends and after games or practice

Meds

Pantoprazole 40 mg daily

Simvastatin 20 mg daily

Metformin 500 mg twice daily

Men’s multivitamin daily

All

Penicillin (rash as a baby)

ROS

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.

PE

Gen

An obese, but healthy-looking man wearing sandals, shorts, and a T-shirt. Oriented × 3, normal mood and affect.

VS

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

Skin

Visible regions are soft and moist.

HEENT

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

Neck/Lymph Nodes

Neck supple, ...

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