Tinea-Manuum (Dermatophytosis) Athlete's foot of the hand

Jul 2 ~ 7, 2011: Dryer weather is obviating the need for daily Domeboro soaks - light to medium work with hand is not aggravating the situation - tight, continuous heavy work with the left hand is avoided/minimized. Underskin bubbling is disappearing - my left hand loves a dry climate like Riverside, CA or Albuquerque, NM or ?San Antonio, TX?

Jun 10 ~ Jul 1, 2011: - ketoconazole applied daily over bubbles which were first noticed Friday night, June 10th; until the 14th when daily Domboro soaked paper towel sections (4 per towel) were held in place by a rubber band over a folded business card pressuring the towel into the skin - various moisturizers applied only to the sore area one to three times a day - mostly once a day.

June 26th 9:20 pm - tiny dab of ketokonazole applied over underskin bubbles that were suddenly noticed after a day of heavy lifting and grabbing with both gloved hands - that concentrated work in one day followed a couple weeks of heavy and intermittant rain that increased the humidity quite a bit - no ketoconazole applied over the following three days. The bubbles appeared about one inch below and inwardly toward the lower mid-section of the palm of the same left hand. (The right hand has never had any of these symptoms or problems.)

February 8th, 2011 - itchy feeling in lower, interior raised palm; gone by the next day.
November 24th, 2010 - waxpaperish feeling still evident.
August 2nd waxpaperish feeling gone/?heavy? feeling still there. Did some pulling and other work with gloves on both hands over the past week without any problems or skin breaks or blistering - the condition is almost to the point of feeling as normal as my right hand has always felt.
July 24th waxpaperish feeling receding
July 14th 1910 ketoconazole & moisturizer mixed together
July 13th 1510 ketoconazole & moisturizer mixed together
July 10th 1725 ketoconazole & moisturizer mixed together
July 7th 1655 ketoconazole & moisturizer mixed together
July 4th 1320 ketoconazole & moisturizer mixed together
June 25th 2000 ketoconazole & moisturizer mixed together
June 24th 2030 ketoconazole & moisturizer mixed together
June 23rd 2110 ketoconazole & moisturizer mixed together
June 22nd 2037 ketoconazole & moisturizer mixed together
June 18th 1315~30 Domboro soak via hand held submersed in shallow pan - the prior long soaking with a rubber glove apparently killed off all of the underskin 'condition' - this was the last soaking needed going into the high humidity summer months.

June 17, 2010:
June 16th nothing (skin very soft from 25 minute gloved soaking yesterday)
June 15th 0935 ketoconazole & moisturizer - 1950~2015 Domboro soaked pad in rubber glove
June 14th 2015~2040 Domboro soaked pad in rubber glove - 2105 ketoconazole & moisturizer
June 13th 1740~1810 Domboro soaked pad in rubber glove
June 12th 2045~1915 Domboro soaked pad in rubber glove
June 11th 1815~1845 Domboro soaked pad in rubber glove - 1915 ketoconazole & moisturizer
June 10th 1815~1840 Domboro soaked pad - 2230 ketoconazole
June 9th 2225~2245 Domboro soaked pad

June 9, 2010:
June 8th 1855~1916 Domboro soak 1935 ketoconazole
June 7th 1915~1940 Domboro soak 2025 ketoconazole
June 6th 0910 ketoconazole 2%, 1750~1745 Domboro soak 1820 ketoconazole
June 5th 1320 ketoconazole 2%, 2030 clotrimazole 1% (& moisturizers)
The condition has restarted with the hotter, more humid weather and my left hand working more than normal - not a lot of stress is being placed on the left hand since that associated with cutting the grass with the push mower on June 1st. Almost daily 1/2 hour bicycling trips puts some stress on it but not as much as the hour associated with the lawn mowing.

June 2, 2010:
June 1st ketoconazole
May 27th & 29th ketoconazole

May 12, 2010:
April 18th, 20th, 28th & May 8th ketoconazole
Lower bodyside palm is still krinkly with brief episodes of imminent rupture of the skin that still remind me to protect it from extreme pressure or puncture; but on the other hand, exercise appears to be strengthening the inner layers of skin - something that makes logical sense.

Apr 14, 2010: Getting toward normal feeling (same as perfectly okay right hand) but still some krinkliness - nothing noticeable on picture.

Mar 31, 2010:
Left palm very slightly krinkly but may be ready for gloved heavy lifting and sweating - roofing work this week will tell the tale.
22nd & 24th ketoconazole

Mar 10, 2010:
The left palm still feels krinkly and unlike the fresh pliability of the right hand - the weather is getting warmer and I'm afraid something is going to happen to restart the condition to the point where my ability to work around the house is impaired for another warm weather working season.

Feb 24, 2010:
17th ~ 22nd 9:55/10:30 pm ketoconazole (not 19th and 23rd)
Both hands were scanned for comparison purposes - the fingers are almost clear with the new bruising on the right coming from hitting things while working on various projects. It was cold enough to make the purplish condition evident when the hands were scanned this morning.

Feb 17, 2010: No scan. Outerskin less krinkly but condition is still felt at base of palm. A small dab of ketoconazole is being applied just before bed each evening since the 13th - that due to the white coloring of the outer skin that wasn't being reduced by the clotrimazole but is less evident with the ketoconazole. The underskin purpling is evident only when it is very cold. Moisturizer is still being applied almost daily, some days more than once.
13th ~ 16th 9:45/10:30 pm ketoconazole

Feb 10, 2010: No scan. Outerskin is still krinkly or not soft and pliable like the right hand - condition still evident underneath - moisturizer still being applied sporadically.
8th 11:25 pm clotrimazole
7th 1:15 pm ketoconazole 20:45 pm clotrimazole

Feb 3, 2010: No scan and nothing new about which to comment.

Jan 29, 2010: A pseudo-paper cut occurred this morning while preparing a three week supply of breakfast oatmeal combined from various separate packets. It happened when I grabbed a bunch of empty packets to toss in the trash. The relative ease with which it happened proves the fragility of the outer layer of skin over the underlying, still extant but hard to discern with the naked eye condition - the underlying skin hopefully thickening without antibiotics, eventually, to keep this from happening again when the warmer 'working' season begins anew and I start using my hands much more aggressively than this morning. A dab of Tincture Merthiolate (1:1000) was put atop it after the scan - just as with a normal skin cut that requires more than mere cleansing.

Jan 27, 2010:
26th: 7:50 am clotrimazole applied when outermost layer of skin has several almost flaky areas concentrated in the middle of the palm; moisturizer still applied once a day or less.
25th: 6:06 am & 9:10 pm clotrimazole
21st: 4:50 pm clotrimazole

Jan 20, 2010:
13th ~ 19th moisturizer applied once a day or less - condition is very slightly purplish under thickening skin and can be felt but not seen as readily as in the past. Some very slight and tiny flaking of otherwise smooth outer skin above the thinner but hardening underskin. Hand is about 90% back to full functioning but not much work that requires washing it a lot is being done.
NO HAND SCAN/PICTURE UNTIL NEXT WEEK.

Jan 13, 2010:
6th ~ 12th moisturizers applied as needed but not much and not often; a couple episodes of slight itchiness this past week were alleviated by moisturizer - the 'condition' becomes purple and highly evident when the skin becomes cold. No medication applied since the 1st day of this month.

Jan 6, 2010:
2nd ~ 5th only moisturizer now being applied as needed.
1st - 12:40 pm soak 1305&2218 ketoconazole 1320&2210 SoftSense.
31st - moisturizers applied four times during the day.

Dec 30, 2009:
30th - 8:20 am Vanicream SoftSense CeraVe moisturizers during day.
29th - 7:45 pm SoftSense moisturizer 2150 wash&soak 2240 SS.
28th - 8:45 pm wash&soak 2115 SoftSense.
27th - 12:30 pm w&s 1330 ketoconazole 1420 SoftSense 2215w&s 2245keto.
26th - 13:40 pm w&s 1422keto 1530SS 2205w&s 2240keto 2245SS.
25th - 8:50 pm w&s 1050keto 2110SS.
24th - 8:00am ~ 10:30am SnowShoveling 1030postulization 1445wash&soak 1520ketoconazole 1749 & 2150 SoftSenseMoisturizer.

Dec 23, 2009:
23rd - 7:50am Vanicream application - skin is unbroken but still with ridges of older skin where it had been broken before; will be using once of twice daily 1:30 Domeboro soaks until those ridges disappear; underskin purpling is still evident at the lower right spot; 2125w&s 2207clotrimazole.
22nd - 8:10am wash&soak 0840clotrimazole 2130Wash&soak 2222Keto 2250moisturizer
21st - 7:20am wash&soak 0740ketoconazoleX2 0748vanicream 1725wash&soak 2112softSense (senilePurpura inside middle finger next to index finger spot and between knuckle & back of hand)
20th - 8:05am wash&soak18min 0840clotrimazole 1705wash&soak 1726naftifine
19th - 7:00am nothing all day (senilePurpura below nail of index finger)
18th - 8:00am ketoX1&moisturizer
17th - 6:40am ketoconazoleX3 5:52pm moisturizer 9:32pm wash&KetoX1

Dec 16, 2009:
10:46 pm moisturizer; 10:03 pm ketoconazole; 2130~47 Domeboro soak 1:30; 2125 hand wash with baby shampoo.
3:00 ~ 4:00 pm moved several loads of building material from the next alley over to my house - thereby placing a lot of stress on my hands. [ A fall while bringing the first (over)load down a steep slope with the hand truck may have initiated this year's bout of senile purpura that began to display itself three days later - the bump just below my left knee was evident immediately but only required one day with the knee brace and has not hampering my speed walking. ]

Only the ketoconazole remained in the treatment plan over the past 24 hours - it being applied in a small, kernal of corn sized dab atop the two remaining hard areas of infection and then spread thinly around the rest of the inner palm. Dry rather than moist skin appears to be my friend during this ?final? stage of this year's lengthy period of disability. (Am getting hopeful this is all coming to an end - have wasted so much time over the past two months treating and tracking all this that hardly anything else has been accomplished and my TODO list is getting a lot larger with new family history related Google Alert finds for newly uploaded stuff on the internet emailed to me almost every day.)
  Tuesday 15th - stopped washing the palm (it's not getting dirty from any work) with baby or other soap.
  Monday 14th 4:20 pm - 2 hours after the last 16 minute Domeboro soak I began applying a dab of ketoconazole 2% cream on two areas at the bottom of the palm that are hard and distinctly discolored - the remainder is then spread thinly over the rest of the inner palm - stopped applying moisturizer that was helping but now also seems to aggravate the situation - the aluminum acetate (Domeboro) soaks have also been terminated as ?no longer needed?.
  Sunday 13th - stopped clotrimazole application - it had appeared to help but now, three days later, seems to aggravate the situation.
  Thursday 10th - small dab of clotrimazole 1% cream spread over several areas noted in the 12/9 hand scan - several minutes after the pre-sleep Domeboro soak.

Dec 9, 2009:
Stopped applying the clotrimazole after last Wednesday night's Domeboro soak. The change has been dramatic. It appears that at a certain stage of the healing process, the topical/external medications do more harm than good. The squishiness and bubbling have disappeared. The hardened areas of still abnormal skin appear to be steadily being pushed out by good, clean layers of regenerated skin underneath - WITHOUT ANY TOPICAL OR INTERNAL MEDICATIONS. Am crossing my fingers that the hand will be back to normal within the next week or two - am able to use it normally now with even an hour of snow shoveling done this morning before the soak.

Dec 2, 2009:
The underskin bubbling, squishy areas still appear to be unaffected by the aluminum acetate soaks or Clotrimazole. Have requested a peer review by other dermatologists at Aurora to see if anyone is willing to replicate the successful treatment plan of 16 years ago activated by Dr. Chen on 9/23/1993 - she might now be practicing in Palo Alto near Stanford University, 2,000 miles away.

Nov 28, 2009: Spoke too soon on the 24th - the layers of skin between the innermost and outermost are still getting soft or squishy in irregular patterns. Am back to twice a day Domeboro (aluminum acetate) soaks of 15 minutes each.

The latest communication from the doctor's office indicates that I should get a second opinion from one of the other dermatologists if my condition does not get better. This latest doctor doesn't know what it is and apparently doesn't care, but he does know what it is not and refuses to replicate the treatment for the EXACT SAME condition that succeeded in less than 30 days 16 years ago. In other words, I've yet to find anybody who cares to treat or even discover what I have or who would be willing to replicate the successful treatment plan used 16 years ago. (They didn't know what I had 16 years ago, either, but did treat it to a manageable conclusion. Although the condition reappeared almost every year after that success, I had the medication that prevented it from immobilizing my left hand - that medication finally used-up early this year and hence the present problem.)

I get the feeling that, like many other circumstances involving 'profit making' enterprises these days, my condition doesn't involve enough profit to warrant enough attention. The medical profession would rather have me waste my time and money going from dermatologist to dermatologist until I find one willing to resolve the problem. No thanks.

Nov. 25, 2009:
Talked with the dermatology nurse at the Whitefish Bay clinic. She indicated that the lab results came back negative for a fungal infection - something I've known for 16 years but that all medical personnel appear to obsess over. Even when I say I know it's NOT A FUNGAL INFECTION, they still hear the opposite and proceed to waste time chasing down that blind alley. This is all very disheartening - more so because I can't write my own prescription to get the medicine that worked 16 years ago FOR WHAT WAS THEN ALSO KNOWN NOT TO BE A FUNGAL INFECTION..

Also discussed this web site (with weekly pictures of my hand) and replied that the current course IS NOT WORKING after she passed the doctor's advice to CONTINUE THE PRESENT COURSE. I emphasized the fact that the 2 week course of cephalexin 500mg twice a day and 6 week course of griseofulvin 250mg twice a day used back in 1993 (16 years ago) resolved the situation within 30 days and it's now been FOUR TIMES THAT AMOUNT OF TIME since I presented my condition to 'medical personnel' back on 7/21/09. I also requested that the MyAHchart process be used for communications since that appears to work better for me.

So far, none of the almost dozen medical personnel I've told about this web site have asked for the web address in order to see it and the pictures and history on it for themselves. Reinventing the wheel appears to be the order of the day every day within the medical profession. [ I realize all these extraneous comments don't make me look good to those professionals or others sympathizing with them but, hey, I'm the one suffering from the condition that the medical profession seems not to be motivated enough to want to resolve but has lobbied legislators to make sure only they have the 'legal authority' to treat and/or resolve it. ]

Nov. 24, 2009: The blistering, bleeding and other highly apparent attacks on good, live skin seem to have stopped temporarily. One 15 minute soak a day after cleansing the hand with Johnson's Baby Shampoo is now sufficient as the skin on the hand thickens enough to withstand further attacks by whatever it is that's causing the deterioration. The colder weather is also undoubtedly helping a lot. Am still using Clotimazole whenever itching becomes noticeable with frequent applications of moisturizers when the Clotrimazole and/or skin dries. (The hand has been clearing up since the last major attack around the 9th & 10th, two weeks ago, when the Triamcinolone ointment was also discontinued.)

The soaks apparently harden the topmost layer of live skin while separating the outermost 'dead' layer immediately above it - thereby allowing the dead layer to slough-off to expose the live layer to the air which hardens it more and perpetuates the whole 'good live skin' thickening process. Soaking too long may work against the hardening - 15 minutes seems about right - 30 minutes was too long. Am awaiting a message regarding the lab results and possible internal medication that will resolve the problem much faster. A message was left on my machine from the ?nurse? at the Silver Spring clinic early in the afternoon just after my daily Villard Library internet session - I didn't notice it there (blinking red light) until around 6 pm. Will have to remind them to use 'THEIR' much more efficient online communication process - the messages section there checked by me just before logging off around 1:30 pm.

Nov. 21, 2009: Sent a progress message to Dr. Grekin via the newly initiated MyAHChart process. Am down to three 15 minute soaks every 48 hours or so, with small dabs of Clotimazole applied when dry itching occurs - followed by several applications of various types of moisturizers as the skin dries during each day and night.

Nov. 18, 2009: Scanned my hand before soaking it or applying Clotrimazole but after several applications of moisturizing hand lotion since last night's 15 minute soak.

Nov. 10, 2009: Updated this web page and skipped the medication () until the 3rd, pre-sleep soak. The greasy ointment may be smothering the healing process that might need some external airing at times. None of the medicated creams/ointment used so far this year are killing off whatever it is inside my body that continues the blistering that breaks through the skin to cause it to steadily deteriorate toward my lower palm and wrist - just as it did in September 1993 and was apparently stopped by the Griseofulvin and Cephalaxin pills prescribed by Dr. Diana Chen back then.

4:20 pm - Noticed and subsequently scanned one red and one white pimple under the skin after this afternoon's 2nd 30 minute aluminum acetate soak of the day.

Nov. 9, 2009: Scanned my hand before soaking it for 30 minutes and applying the morning regime of medication and moisturizer. Yesterday morning, there were three distinct areas of liquid filled blisters that I noticed for the first time - they drained and flattened out while going about my routine Sunday morning tasks (the image shows the general areas, not the blisters.)

The orange-brown areas at the lower edges of the wound, with darker red-brown spots of concentrated ?infection? are steadily expanding and not responding to the clotrimazole, naftifin, ketoconazole and triamcinolone creams/ointments having been applied to the wound, in that order, since July 21st, 2009 - (109 days - it took less than 40 days to stop that deterioration 16 years ago, as the pictures below prove). Only the aluminum acetate soaks for 30 minutes at a time in 1:40 concentration appear to have any 'noticeable' affect but it doesn't last or prevent the steady eating away of the lower edge of skin.

What has not been repeated from the highly successful' 1993 treatment plan is the 2 week course of Cephalaxin 500mg BID along with the 6 week course of Griseofulvin 250mg BID, primarily because the VA never took scrapings to send to a lab when I first presented myself to them on July 21st and it took until October 23rd to get to a private dermatologist to do so AND it takes 30 days for the cultures, etc. from those tests to present the results. And, rather than criticize the latest dermatologist from reinventing the wheel for this reoccurrence, I'm giving him the slack and time to discover all the evidence before prescribing the medications that will finally resolve the problem.

Nov. 5, 2009: Dr. ?? (they don't hand out cards or other documentation) took skin scrapings to look at under the microscope but dismissed me (in more ways than one) before sharing (NOT!) the results. He said he'd recommend me getting VA Dermatology attention instead of at a private doctor. He also saw something on my left foot that only dermatologists can see - me not thinking anything there is serious enough to get medical attention. My attitude toward present day medical personal, including dermatologists continues to flatten to the lowest possible plateau one can reach.

I'm busy researching and attempting to use the drying aluminum acetate soaks to cure this thing that's already gone a couple months beyond the point it took 16 years ago to cure to a noticeable degree. It still seems that the griseofulvin (250mg) and cephalexin (500mg) taken twice a day 16 years ago is what probably killed the crusting growth that steadily eats away the new skin at the lower edges. None of the doctors I've seen to date appear to want to repeat those medicines - they maybe wanting to see my hand fall off before taking it seriously.

The regimen outlined on the 11/3/09 doesn't appear to be doing much to improve my situation. Will have to wait until the 30 day lab results from Aurora come back to Dr. Grekin and he contacts me.

Oct. 30, 2009: Called to pass along a message for Dr. Grekin that the Triamcinolone 0.1% ointment prescribed last week is doing no better than the Clotrimazole having been applied twice daily before then. The skin is still blistering and peeling (while damp from the ointment) toward the bottom of my palm - it will be soon be as bad as it was in 1993. His nurse handled the messages between us with the end result that I bought a 12-powder-pack of Domeboro Aluminum Acetate ($15.83 w/tax) to put in water for 15~30 minute hand soaks up to thrice daily. (Dr. Grekin had recommended Burow's but CVS only had the Domeboro on the shelf.)

Oct. 23, 2009: Dr. Grekin took a sample for lab tests, prescribed Triamcinolone 0.1% ointment and provided printouts for:

We'll discuss the next step via telephone after he has the lab results. He was pretty confident that what he prescribed will clear it all up in no time - me very skeptical and stating I'd be VERY SURPRISED if anything cleared it all up without seeing it come back every year.

Their location in Glendale is three blocks from the bus stop with NO SIDEWALKS half the way - meaning I'd be taking my life in my hands walking in the EXTREMELY FAST traffic along that stretch of Good Hope Road each visit, especially when deep snow prevents walking anywhere but in the roadway. The alternative location in Whitefish Bay is no better in the winter for having to trudge through deep snow between far flung bus stops.

Dr. Grekin confirmed it's not fungal and not bacterial - leaving systemic, I guess, which is what I've thought ever since it began recurring every year since back in 1995. That is, it's not Tinea Manuum and the Candida Albicans lab results from September 1993 make no sense and have been ignored by everyone seeing them.

Left my umbrella at the Walgreen's at Teutonia & Good Hope and got a quote of $24 for the 30gm Triamcinolone. Bought it at the local CVS Pharmacy 2 blocks from me after joining their 'drug club' (or whatever it's called - the receipt doesn't show it and I can't remember what the clerk called it) for only $6.71 after their initial estimate of $24, also.

Oct. 22, 2009: Received 100 pages of medical records and lab reports from VA - 75% of which were generated since 2004.

Oct. 21, 2009: Called Sharon at Aurora to confirm receipt of her form and to see if she'd received VA records, yet, and if there was anything else needed from me - nothing needed from me but she hadn't received anything from the VA, yet.

Oct. 15, 2009: Received "Authorization for Disclosure of Health Information" form from Aurora, completed it and faxed the signed & dated front page to Carol at the VA records release department with a request for an additional copy be mailed to me - Carol had indicated that since there were probably very few pages involved, he could make an extra copy and have it sent to me.

Oct. 13, 2009: Contacted Sharon at Aurora & Carol at the VA records releasing sections regarding having my medical records sent (via fax) between them.

Oct. 9, 2009: Received a letter from the VA Regional Office with an appointment on Nov. 5 for COMP & Pens Dermatology Clinic at the VA Hospital. Called to see if they could handle both the 'new claim' analysis and treatment - the treatment merely being to issue a prescription for some grieseofulvin and/or cephalaxin. Nope, they can't do two things at one time - too much of a backlog. Duh, maybe the backlog is due to their not being able to do one thing at a time, let alone two. Had they made time to see me back in July or August, I wouldn't have filed the new claim on September 1st in order to get some respect and the treatment that comes from respect.

Griseofulvin (250mg) for Tinea-Manuum at www.ecureme.com & Cephalexin (500mg - antibiotic) at eHow.com

Those are the internal medicines (pills) that appeared to work back in 1993 with a 2 week course for the Cephalexin and 6 week course for the Griseofulvin.

Sep. 17, 2009: Set up an appointment to see a Dermatologist at the nearest location (Aurora Advanced Health Care) for Oct. 23rd.

Sep. 16, 2009: New Primary Care Physician visit to the Yellow Clinic at the VA hospital. He set up a dermatology referral and indicated they'd contact me within 3 days. Got home to find a letter mailed the previous day from the VA stating they couldn't handle dermatology and that I should find my own and have the bills sent to the VA.
Never heard anything as a result of this 'redundant' visit - assume the VA Dermatology people ignored the 2nd, redundant request as they had (so far as the computer system records went) for the first one made by Dr. Maglio in the Emergency Room on Sep. 1st. Those records did not reflect the fact that they'd mailed out the forms and request for me to see a private physician the day before my visit with Dr. Haller, my new Primary Care Physician. Had they done so, he would have found it and wouldn't have wasted his time making another request - (and the Dermatology folks wouldn't have had the extra, redundant request that further increased their backlog that presumably prevents them from seeing actual patients instead of all the paperwork associated with them.)

Sep. 1, 2009: Revisited VA Emergency Room. Still not able to see a dermatologist. Condition is stabilizing but not getting better. Have an appointment for a Primary Care Physician on the 16th and should be contacted by the dermatology 'specialty' before that.

July 21,2009: Presented myself to the VA Emergency Room to request new tubes of ciclopirox and ketoconazole cream. Was provided clotrimazole and naftifine instead, the latter proving to make the cracking, crusting and spreading worse. No scrapings were taken for lab testing. I was left with the impression that the 'newer' meds provided to me would clear it all up.