Question of the Week # 251

251 )  A 65 year old woman is evaluated in your office for pain in bilateral feet for the past four weeks. The pain is burning in quality and is associated with intense itching. Her past medical history is significant for difficult to control Type II Diabetes Mellitus. Her recent HgbA1C was 7.9% and Creatinine was 1.8mg%.  On physical examination, she is obese, afebrile and in no apparent distress. She has diminished pinprick and vibration sensation in glove and stocking pattern in bilateral upper and lower extremities. Dorsalis pedis and posterior tibial pulses are mildly diminished. There are multiple erythematous tiny vesicles between the toes and on the plantar aspect of the both feet.  Which of the following is the most appropriate treatment option for this patient’s pain?

A)      Oral Pregabilin

B)      Topical Corticosteroids

C)      Oral Cefazolin

D)     Topical Terbinafine

E)     Topical Acyclovir

9 Responses

  1. i think it is topical steroids as it can de due to dermatitis as dry skin can cause burning and itching

  2. a- oral pregabalin

  3. a

  4. a- oral pregabalin

  5. A) Oral Pregabilin
    diabetic neuropathy

  6. A…..for the pain

  7. aaa

  8. D:) Inflammatory/vesicular tinea pedis
    Painful, pruritic vesicles or bullae, most often on the instep or anterior plantar surface, characterize the inflammatory/vesicular type.
    The lesions can contain either clear or purulent fluid; after they rupture, scaling with erythema persists.
    Cellulitis, lymphangitis, and adenopathy can complicate this type of tinea pedis.

  9. Athlete’s foot. Treatment = terbinafine

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