Clue to this condition is in the nails

This man was thought to have bilateral cellulitis because of the ascending red areas with a sharp upper edge on both calves.

He had some oedema from cardiac failure which added to the impression. However the clue to the correct diagnosis is in the thick great toenail which suggests a subungual tinea infection. The rash on both lower limbs was a gross tinea infection of the skin and nails slowly moving up his legs. It is unusual to see this condition so symmetrically. Skin and nail scrapings were taken for KOH microscopy and culture and he was started on oral terbinafine 250mg daily for three months to clear the nail infection. The skin will clear after about a month of therapy. For other images log into www.skinconsult.com.au