Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review.
F Hall Reynolds, Mark G Tusa, Samuel L Banks
PMID 37224470WHAT IT FOUND
Toe web psoriasis is a rare mimic of fungal infection that fails standard antifungal and antibiotic treatments.
If interdigital maceration persists despite negative fungal cultures and topical therapies, consider a biopsy to rule out inverse psoriasis.
Key findings
01Interdigital psoriasis is a rare form of inverse psoriasis that frequently mimics toe web infections, often leading to misdiagnosis.
02In the reported case, the patient's condition cleared only after switching from antimicrobial treatments to systemic apremilast, a medication for psoriasis.
03Negative fungal cultures and Wood's lamp examinations do not exclude dermatophytes, but persistent maceration with negative tests should prompt consideration of non-infectious causes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic one, so it is subject to author selection bias. The clinical evidence rests on a single case report, which cannot establish general efficacy of apremilast for this condition. The review does not provide diagnostic criteria or sensitivity/specificity data for distinguishing psoriasis from infection in large populations.
Declared interests
The authors disclosed no financial relationships.
The easy way to misread this
Do not assume all recalcitrant toe web maceration is psoriasis. This paper reports one case; common causes like resistant fungal infections, contact dermatitis, or other systemic conditions must be ruled out before initiating immunomodulatory therapy.