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Residency Insight

ID Reaction

By
Daniel Bell, DPM

Clinical photos courtesy of
Jay Lieberman, DPM

A 44 year old male presents to the clinic with a 1 week old history of extremely pruritic generalized eruption involving his feet, forearms and hands, neck and trunk.

He states that he noticed a pruritic rash involving his feet 2 weeks prior. He had not sought any treatment. He noticed his eruption on his feet worsening before spreading and becoming generalized.

PMH: hypertension
ALL: NKDA
MED: beta blocker

Hint: the rash on the feet preceded the arms and trunk

PHYSICAL: Examination reveals a maculopapular erythematous lesions, symmetrical in distribution, involving the arms and hands, trunk and neck. The plantar aspect of the feet reveals the presence of patchy fine dry scaling with small vesicles on a erythematous base in a symmetrical distribution.

Hint: sounds like Tinea Pedis ??)

The correct diagnosis is ID reaction.

ID reaction is a generalized acute cutaneous reaction to a variety of stimuli, such as infectious and inflammatory skin conditions. It involves a pruritic rash that is characteristically distant from the inciting location. Clinical manifestations are variable and depend on the etiology of the eruption. Lesions are usually at a site distant from the primary infection or dermatitis. This secondary rash is immune mediated. In this case, it was a delayed type hypersensitivity reaction to intradermal trichophytin, the tinea pedis infection itself..

ETIOLOGIES

Infections with dermatophytes, mycobacteria, viruses, bacteria, or parasites
Contact dermatitis, stasis dermatitis

DIAGNOSIS

Positive skin test finding for a dermatophyte infection
Absence of fungi in the distant
Lesions with clearing of the lesions after the fungus is eradicated.

TREATMENT

Systemic or topical cortocosteroids at the site of the ID reaction
Wet compresses at the site of the ID reaction
Systemic or topical antihistimines at the site of the ID reaction
Appropriate treatment at the primary site of the precipitating skin condition

Letters to the Editor

From:      Gayle Johnson, PMAC
                  Editor, Footzine
                  National Ezine for Podiatric
                  Medical Assistants
Subject:   Residency Insight Article on
                  Mentorship in Podiatry

This was very nice, and so true. Over the years I've watched lots of residents and preceptees process through the offices I've worked in. Some of them told me later that it was only after they were in their own practices that they really appreciated what they learned (and grumbled about) in our offices.

I've also observed that there are similarities in the office set-up, forms used, personnel policies, instrumentation and supply preferences among podiatrists who were trained in the same programs.

You've created another great forum for this profession, Alan. I look forward to seeing where else you take it. :)

Gayle Johnson, PMAC
Editor, Footzine
National Ezine for Podiatric Medical Assistants
gaylejohnson@footzine.com

From:      Charles Foster, DPM
                  Director, DVA - Boston
                  Healthcare System
Subject:   Kudos to PRESENT Courseware

Keep up the great work! My life has been made so much better by this program!!

Charles Foster, DPM
Charles.Foster5@med.va.gov

From: Michael Cohen, DPM
Director, DVA Miami
Subject: Residency Insight Feedback

All I can say is excellent!!! You guys are filling a void that is long overdue. Moreover PRESENT is an excellent tool that is closing the gap in residency education and bringing it a step closer to standardization.

Michael Cohen, DPM
Michael.Cohen@med.va.gov

From:     Terry Weaver, DPM
                 Director, DVA Medical Center
                 Lebanon PA
Subject: Next year's programs

I am the residency director at the VA Medical Center Lebanon PA. I have enjoyed your on line lectures and incorporated them into our program. I understand these lectures were supported by a grant for 2003-2004 academic year. Can you tell me what will be available for 2004-2005 academic year starting July 1, 2004? Will the VA still receive these lectures free? If not how much will it cost?

Terry Weaver, DPM
Terry.Weaver@med.va.gov

NOTE FROM EDITOR:

I am very pleased to announce that Healthpoint has stepped up and agreed to sponsor the entire VA system again for a 2nd year, including your hospital. This company is now providing supplementary academic programming to the largest single group of residents in the world ! Our hats are off to Scott Goodridge and the entire Healthpoint company for the huge contribution that they continue to make to podiatric medical education. I would encourage you all to consider the use of their fine products for your patients with slow healing wounds.

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