Question

A 30-year-old nurse whose job requires frequent hand washing has noticed a small erosive skin lesion in the third web space of the right hand. The best therapy for this condition would be

• A. Topical 5-fluorouracil
• B. Topical clotrimazole
• C. Oral griseofulvin
• D. Topical hydrocortisone

Hint:

Wet hands and macerated skin between the fingers - think about which organism thrives there.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The question asks for the best treatment for an erosive lesion in the finger web space of a nurse with heavy occupational water exposure.

Step 2: Key Concept or Approach:
Chronic wet work macerates the skin of the finger webs, creating the perfect environment for Candida to colonize and cause erosio interdigitalis blastomycetica, an erythematous, erosive, macerated patch typically seen in the third web space, which stays the wettest.

Step 3: Working Through the Options:
Because this is a candidal infection, an azole antifungal such as topical clotrimazole is the correct treatment, together with keeping the area dry. Topical 5-fluorouracil is a chemotherapeutic, antimitotic agent used for actinic keratosis and superficial skin cancers, not for infection. Oral griseofulvin treats dermatophyte, or tinea, infections and is not reliably active against Candida. Topical hydrocortisone is a steroid that would reduce inflammation but does nothing to clear the underlying fungal infection, and can even make it worse.

Step 4: Conclusion:
Topical clotrimazole is the correct therapy, so that is correct.