Identifying the Difference: Dyshidrosis or Athlete's Foot Blisters?

I'm not sure if it's dyshidrotic eczema or tinea pedis with vesicular lesions?

Hello, Doctor: A few days ago, I developed a blister on the sole of my foot while jogging.
After it burst, I just peeled it off myself.
Initially, there were no issues, and it was just an aesthetic concern due to the uneven skin.
However, recently I noticed that blisters (not superficial, but within the thick callus) have started to appear at the edges of the uneven skin, and they are very itchy.
I try not to scratch them, but they form hard lumps, and I often feel the urge to scratch when I accidentally touch them, which is quite bothersome.
After seeing a doctor, I was prescribed two medications: 1.
Moisturizing cream and 2.
Terbinafine.
Although the uneven skin has started to heal, the blisters continue to form hard, itchy lumps.
I'm unsure if I have dyshidrotic eczema or athlete's foot.

Rex, 20~29 year old female. Ask Date: 2015/12/21

Dr. Wu Yuxin reply Dermatology

A literal description is not sufficient to confirm the diagnosis without actually seeing the lesion.
It is recommended to have a dermatologist evaluate it for proper assessment.

Reply Date: 2015/12/21

More Info

When distinguishing between dyshidrosis (also known as pompholyx) and athlete's foot (tinea pedis), it is essential to consider the characteristics of the symptoms, their location, and the underlying causes.

Dyshidrosis typically presents as small, itchy blisters on the palms of the hands, sides of the fingers, and soles of the feet. These blisters can be filled with clear fluid and may appear in clusters. The condition is often associated with sweating, stress, or exposure to certain allergens. After the blisters burst, they can lead to dry, scaly skin, and sometimes, the affected areas can become thickened or develop calluses. The itching can be intense, and the skin may feel tight or uncomfortable.

On the other hand, athlete's foot is a fungal infection that usually affects the spaces between the toes and the soles of the feet. It often presents with symptoms such as itching, burning, and stinging sensations. The skin may appear red, flaky, or scaly, and blisters can form, which may also burst and lead to crusting. Athlete's foot is commonly caused by a fungus that thrives in warm, moist environments, such as sweaty shoes or locker rooms.

In your case, the presence of blisters that form under thickened skin (calluses) and the intense itching you describe could suggest dyshidrosis, especially if these symptoms are exacerbated by sweating or stress. The fact that you have already seen a doctor and received topical treatments like "守膚" (a skin barrier cream) and "紫菌素" (an antifungal medication) indicates that your doctor is considering both possibilities. If the treatment has not resolved the symptoms, it may be necessary to reassess the diagnosis.

Here are some key points to consider:
1. Location of Symptoms: If the blisters are primarily on the soles of your feet and between your toes, athlete's foot is more likely. If they are on the palms or sides of the fingers, dyshidrosis is a stronger possibility.

2. Appearance of Blisters: Dyshidrosis blisters are usually small and deep-seated, while athlete's foot blisters can be larger and more superficial.

3. Response to Treatment: If antifungal treatments do not improve your condition, it may indicate that the issue is not fungal in nature, leaning more towards dyshidrosis.

4. Associated Symptoms: Dyshidrosis often comes with a history of eczema or atopic dermatitis, while athlete's foot may be associated with a history of fungal infections or exposure to contaminated environments.

5. Chronicity and Recurrence: Dyshidrosis can be chronic and recurrent, often triggered by stress or environmental factors, whereas athlete's foot may recur due to reinfection or persistent fungal spores in footwear.

Given your symptoms and the treatments you've tried, it would be advisable to follow up with your healthcare provider. They may consider a skin scraping or culture to definitively rule out a fungal infection if they suspect dyshidrosis. Additionally, they might recommend other treatments, such as corticosteroids for inflammation or other topical therapies to manage itching and discomfort.

In summary, while both conditions can present with blisters and itching, their underlying causes and treatment approaches differ significantly. A thorough evaluation by a healthcare professional is essential to determine the correct diagnosis and appropriate management plan.

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