Bilateral Vesicular Eruption Between Toes in Young Athletic Male

Case at a Glance

A 25-year-old athletic male presents with acute onset of bilateral vesicular lesions confined to the interdigital spaces of both feet, with left foot more severely affected.

Patient's Story

The patient is a 25-year-old male, height 5'10", weight approximately 140 lbs, who noticed clusters of small fluid-filled lesions between his toes that appeared overnight. He maintains an active lifestyle with regular gym attendance (3 times weekly) and running (once weekly). His current medications include vitamin D supplementation, finasteride, and Descovy for PrEP. He has no significant past medical history and denies tobacco use. The patient initially suspected athlete's foot due to his athletic activities and gym exposure.

Initial Assessment

Physical examination revealed bilateral vesicular lesions localized to the interdigital spaces, with the left foot showing more extensive involvement. Notably, the remainder of both feet appeared normal without additional rash, scaling, or other dermatological changes. The patient reported no associated symptoms such as itching, pain, or systemic complaints.

The Diagnostic Journey

Initial clinical presentation suggested possible infectious etiology given the patient's athletic activities and gym exposure. However, the acute overnight onset, bilateral symmetric distribution, and vesicular morphology prompted consideration of alternative diagnoses. The localized nature of the eruption without broader foot involvement made typical athlete's foot less likely.

Final Diagnosis

Vesicular foot dermatitis (dyshidrotic eczema) - based on the characteristic presentation of acute-onset vesicles in the interdigital spaces with bilateral involvement and absence of broader dermatophytic features.

Treatment Plan

Management focused on symptomatic relief and prevention of secondary infection. Topical corticosteroids were recommended for inflammation control, along with keeping feet dry and well-ventilated. Patient education included proper foot hygiene, use of moisture-wicking socks during athletic activities, and avoidance of potential triggers.

Outcome and Follow-up

Patient was advised to monitor for resolution over 1-2 weeks with prescribed treatment. Follow-up scheduled if symptoms worsen, spread, or fail to improve. Additional dermatological consultation recommended if recurrent episodes occur to explore potential triggers and long-term management strategies.