# Psoriasis Vulgaris Masked by Tinea Pedis in Two Unhoused Patients

## TL;DR

Two unhoused patients were initially misdiagnosed with tinea pedis but were later found to have psoriasis, which did not improve with antifungal treatments.

## Contribution

This case study highlights the misdiagnosis of psoriasis as tinea pedis in unhoused individuals and the challenges in treatment adherence.

## Key findings

- Initial treatment with antifungal creams failed to improve symptoms in both patients.
- Psoriasis was correctly diagnosed after a full-body examination revealed characteristic symptoms.
- Non-compliance with treatment led to complications such as cellulitis in one patient.

## Abstract

Psoriasis is a chronic inflammatory disease characterized by clearly marginated silvery plaques that affect men and women equally. Symptoms can vary among individuals; typically, it presents on the scalp, elbows, and knees. We present two cases of patients initially diagnosed with tinea pedis who showed no improvement with medical treatment. The first patient is an African American male in his 50s who arrived at a free clinic for unhoused persons with lesions to both feet initially diagnosed as tinea pedis. Although the patient was compliant with applying topical formulations of tolnaftate and clotrimazole, there was no discernible improvement in his symptoms and the skin lesions. After a thorough examination of the skin throughout the entire body, the diagnosis of psoriasis was considered. The patient started treatment with steroidal cream with improvement of the symptoms and lesions. The second patient is a Caucasian male in his 20s who also presented initially with complaints of a dry, intensely pruritic, and scaly rash on the dorsum of both his feet, as well as in between the digits of his feet for which an initial diagnosis of tinea pedis was also made. The patient remained non-compliant with treatment and, after reevaluation of his lesions along with an extensive survey of his body, was deemed to have psoriasis and prescribed topical hydrocortisone. The patient continued to remain non-compliant with his therapeutic regimen and subsequently developed cellulitis which is yet to resolve with treatment.