CHART NOTE HISTORY: This is a 42-year-old white male with the persistent inflammatory ulceration on the dorsum of his

right foot which began as athletes foot. The patient reports a similar dermatitis approximately five years ago which cleared over several months with an unknown antibiotic. Patient was first seen in the dermatology clinic and was thought to have infected eczema or gram-negative toe web infection and possible contact sensitivity to Neosporin. The patient was started on oral griseofulvin and Burow soaks. Bacterial cultures grew mixed flora including pseudomonas, lactobacillus, and group D strep. Fungal cultures grew yeast, not thought to be Candida albicans. Three weeks ago when I saw the patient, I stopped the Burow soak and griseofulvin started him on potassium permanganate soak and ketoconasol 200 mg p.o. b.i.d. as well as Augmentin 500 mg p.o. t.i.d. and Hibiclens soaks. X-ray showed mild demineralization but no definite osteomyelitis. The dermatitis apparently cleared after three or four days of ketoconasol and Augmentin, but recurred after two weeks. PLAN: It is felt that the patient should be kept on at least six months of oral ketoconasol and could possibly need IV amphotericin B in the future if lesions do appear.