Vesicles on the sole of the foot if unilateral strongly
suggest vesicular tinea. There may be a small bit of scaling as in this case
that should alert you to the possibility of a tinea infection. The vesicles are
due to a type 4 delayed hypersensitivity reaction to the fungal organism and if
florid enough it can make it difficult to actually culture the fungus. This is
often quite itchy. It requires the use of a fungicidal cream such as
terbinafine plus a strong steroid cream to reduce the inflammatory reaction and
relieve the itch. If there is no itch just use the terbinafine cream on it’s
own and it will help the body’s immune system remove the fungus. Cream should
be used for a month BD to make sure the fungus is gone and then applied perhaps
once a week in the longer term to prevent any reinfection. Localised pustules
on the instep are more suggestive of localised pustular psoriasis. See www.skinconsult.com.au
