A Vegan Hiker With a Rash Self-Treated With Coconut Oil

Melba Estrella, MD; Ansley Devore; Alan Snyder; Dirk M. Elston, MD


December 28, 2020

Physical Examination and Workup

Upon examination, the patient is alert and calm but scratches her feet on several occasions. Her initial vital signs include a temperature of 99.0°F (37.2°C), a blood pressure of 128/72 mm Hg, a heart rate of 66 beats/min, and a respiration rate of 16 breaths/min. Examination of the left foot reveals an inflamed, erythematous, oozing plaque that covers the majority of the instep, with superimposed excoriations, scattered vesicles of multiple sizes, and erosions. An identical but smaller edematous plaque is apparent on the dorsal left great toe. Fine scaling is noted at the periphery of the lesions.

Examination of the right foot reveals two similar but smaller oozing, erythematous plaques that are mildly swollen and excoriated. The right dorsal great toe is similarly involved. The remainder of the foot and skin examination reveals no abnormalities. Dull and sharp sensations remain intact bilaterally.


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