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------------------------------------------------ A 19-year-old man is evaluated for 4 to 5 months of persistent itching, thickening of the skin, and odor of the feet. He also has hyperhidrosis of the palms and soles. Medical history is otherwise unremarkable, and he takes no medications. On physical examination, vital signs are normal. There is a substantial odor of the feet, but no changes to the toenails. The axillae and groin are unremarkable. Potassium hydroxide preparation of skin scrapings does not reveal fungal elements.

Which of the following is the most likely diagnosis?

1. Aquagenic keratoderma
2. Erythrasma
3. Keratoderma blenorrhagicum
4. Pitted keratolysis
5. Tinea pedis

Given the patient's symptoms, the negative result for fungal elements, and the characteristic signs of persistent itching, odor, and hyperhidrosis, the most likely diagnosis is Pitted keratolysis.

Explanation:

The symptoms and signs provided, along with the negative result for the presence of fungi in the potassium hydroxide preparation, point towards a diagnosis of Pitted keratolysis. Pitted keratolysis is a bacterial infection of the skin that affects the soles of the feet and, less commonly, the palms of the hands. It's characterized by persistent itching, an unpleasant odor, and hyperhidrosis (excessive sweating). This condition is a result of the breakdown of keratin in skin cells, leading to the characteristic 'pitted' appearance.

or

The most likely diagnosis for the 19-year-old man's symptoms is Pitted keratolysis. This condition is characterized by persistent itching, thickening of the skin, odor of the feet, and hyperhidrosis of the palms and soles. It is caused by the presence of bacteria that produce extracellular enzymes capable of breaking down keratin. The diagnosis can be confirmed through clinical examination and the absence of fungal elements in a potassium hydroxide preparation of skin scrapings.

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