Make the Diagnosis

1. Sore Feet in Barbados



Case Findings: A 28-year-old man returned from a fun vacation in Barbados where he spent time surfing, walking on the beach, and eating a lot of local food. While he was happy with his tan, he was a bit concerned with a rash that he noticed on his foot the week after he returned. The cream for athlete’s foot he had at home was not helping.


Which disease do you diagnose this patient with?


1)    Scabies

2)    Swimmer’s itch

3)    Portuguese man of war sting

4)    Cutaneous larva migrans


For the correct answer, go to the end of this Quiz section


2.  Iraq War Vet’s Rash



Case Findings: A 28-year-old soldier just returned from active duty in Iraq. He said the rash started several weeks ago. It is somewhat pruritic, but otherwise he feels well. He was given doxycycline, but it did not resolve.


Which disease do you diagnose this patient with?

1)    Lyme disease

2)    Leishmaniasis

3)    erythema annulare centrifugum

4)    granuloma annulare


For the correct answer, go to the end of this Quiz section




The correct diagnosis to quiz question one is number 4.


Cutaneous larva migrans is also known as creeping eruption, creeping verminous dermatitis, sandworm eruption, plumber’s itch, ground itch, and duck hunter’s itch. It is a parasitic infestation of a hookworm. It can be acquired from contact with soil or sand contaminated with dog or cat feces. It may not show up for weeks to months after exposure to sand or soil. The eruption is characterized by local itching. Four days after entry, the migration of the larvae begins and then progresses horizontally about 2 cm daily. Larvae may lie dormant in the skin in colder temperatures and become active again when the seasons change.


What To Look For:


1. pruritic, raised, red, serpiginous (snake-like), curvilinear trails with or without papules and/or vesicles

2. lesions most commonly found on ankles and feet

3. lesions occasionally found on buttocks, genitals, hands (or any area that had direct contact with sand or soil)


The correct diagnosis to quiz question two  is number 3 .


Erythema annulare centrifugum (EAC) is a figurate erythema possibly related to hypersensitivity. The etiology of EAC has been postulated to be secondary to infection, inhalants, drugs, and malignancy, but in most cases, an etiologic agent is not identified. Most cases of EAC are idiopathic, but a number of agents have been reported to cause EAC-like lesions including piroxicam, penicillins, and others.


What To Look For:


1. single or multiple erythematous papules (may also appear urticarial) that advance peripherally by millimeters per day

2. erythematous papules eventually form large rings with central clearing and faint brownish pigmentation

3. the ring may have a trailing scale behind the advancing edge

4. lesions are slow moving and usually either arcuate or annular




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