Several months ago, Jeffrey M. Weinberg, MD, discussed a possible diagnosis of dyshidrosis or other form of eczema in a patient with pedal cracking (Item 96-11). In 1985, a 22-year-old woman presented with a six-year history of itching, cracking, and vesiculation on the sole that frequently progressed to raw oozing. She had tried many topical agents, antihistamines, and corticosteroids. Because the symptoms were worse in the spring when the mold count was high and she had greater contact with grass, I did allergy testing and gave her a hyposensitivity shot for molds. Clearance of the rash occurred in two weeks and continues to this day with seasonal allergy shots.
—S.A. Claassen, MD, Bristow, Neb.
This is an interesting observation, which may be worthy of a case report. It has long been postulated that microorganisms, including yeasts and molds, play an influential role in atopic dermatitis pathogenesis, interacting with disease susceptibility genes to cause initiation and/or exacerbation of disease activity. Yeasts belonging to the Malassezia genus have received particular attention. Therefore, there may be a lot of merit in this finding.
—Jeffrey M. Weinberg, MD (105-21)