---

🦶 Pair pe Khujli (Foot Pruritus) — Diagnosis aur Treatment

Pehle Cause Identify Karein

---

🔬 TINEA PEDIS (Sabse Common Cause)

"Infection of the foot is the most common dermatophyte infection and is often chronic; it is characterized by variable erythema, edema, scaling, pruritus, and occasionally vesiculation. The infection may be widespread or localized but generally involves the web space between the fourth and fifth toes." — Harrison's Principles of Internal Medicine 22E

Diagnosis

• KOH preparation — skin scraping microscopy (fungal hyphae dikhenge)
• Culture — confirm karne ke liye
• Nail involvement (onychomycosis) saath ho sakta hai

Treatment — Tinea Pedis

🔹 Topical (First Line — Mild/Moderate cases)

Clinical resolution ke 1 hafta baad tak treatment jari rakhen — relapse rokne ke liye. — Harrison's 22E

🔹 Oral Antifungals (Severe / Recurrent / Topical fail ho)

"Tinea pedis often requires longer treatment courses and frequently relapses. Oral antifungal agents may be required for recalcitrant tinea pedis." — Harrison's 22E

🔹 Agar Bacterial Coinfection ho (Maceration + smell)

• Gram stain/culture karein
• Topical ya oral antibacterial dein (Pseudomonas/Proteus common)
• Dilute acetic acid soaks bhi helpful — especially diabetics aur lower limb edema mein
• Fitzpatrick's Dermatology 5e

---

🪲 SCABIES

Treatment

• Permethrin 5% cream — poore body pe lagaen (neck se neeche), 8–12 ghante rakhen, phir dhoen → 1 hafta baad repeat karein
• Ivermectin oral (200 mcg/kg) — 2 doses, 2 hafta ke andar → severe/crusted cases mein ya topical fail ho to
• Ghar ke sabhi family members ka ek saath treatment zaroori
• Kapde/bedsheets dhoen (hot water)

"Topical permethrin 5% cream or off-label use of oral ivermectin both are effective agents for treatment of scabies. Most experts recommend starting with topical 5% permethrin cream as the drug of choice." — Red Book 2021

---

🧴 ECZEMA / Contact Dermatitis

• Moisturizers (emollients) regularly lagaen
• Mild topical corticosteroids (e.g., Hydrocortisone 1%, Betamethasone 0.1%) — inflamed areas pe
• Antihistamines (Cetirizine 10 mg OD, Loratadine 10 mg OD) — khujli ke liye raat ko
• Trigger avoid karein (synthetic jooton se parhez, dry skin avoid)

---

⚡ Symptomatic Relief (Kisi bhi cause mein)

---

🩺 Kab Refer/Investigate Karein?

• Fungal culture — treatment fail hone par
• Liver function test — oral antifungals shuru karne se pehle
• Systemic cause sochein agar bilateral diffuse pruritus ho: CKD, diabetes, thyroid, liver disease, lymphoma
• Scabies agar immunocompromised (HIV/steroid use) — crusted scabies treat karna mushkil hota hai

---

1. Unglion ke beech khujli + scaling = Tinea Pedis → Topical antifungal
2. Raat ko zyada + ghar mein sab ko = Scabies → Permethrin 5%
3. Dry, red patches + allergy = Eczema → Moisturizer + Steroid cream
4. Har case mein antihistamine symptom relief ke liye de sakte hain