Gram-negative toe web infection is an uncommon bacterial infection of the web spaces, usually precipitated the constant wearing of shoes. Initially, the toe web becomes white and macerated. Later, wetness, inflammation, and odor develops. In the full-blown setting, the web spaces of all toes are eroded, malodorous, and inflamed. In a review of 123 cases [JAAD 45;537], Pseudomonas aeruginosa was the prevailing pathogen, but E. coli, Proteus mirabilis, and Morganella morganii were also found. A male:female ratio of 4:1 was seen.
A bacterial culture should be done, but ciprofloxacin or another antibiotic with activity against gram-negative bacteria should be started before the results are available. Ideally, the patient should not wear shoes until healing has occurred. Vinegar soaks twice or three times a day should be done to reduce the bacterial load and to dry out the feet. Topical gentamicin (e.g., Garamycin) can be quite helpful. Many patients need time off work. The patient needs close followup during the healing process. After several days of antibiotics and drying out the feet, a topical steroid ointment may need to be added as eczematous changes of the feet are very common.
Once the initial inflammatory condition has been cleared, the feet, and especially the nails, should be studied for the presence of dermatophyte infection. If onychomycosis is present, it should be treated to prevent recurrence.
Gram-negative toe web infection with id reaction.
The green discoloration indicates the presence of Pseudomonas.
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