Differential Diagnosis for Bilateral Feet with Peeling Skin, Holes, Scaly Patches, and Macerated Interdigital Space

• Single Most Likely Diagnosis
  • Athlete's foot (Tinea pedis): This condition is characterized by peeling skin, scaly patches, and macerated interdigital spaces, which matches the description provided. It's a common fungal infection affecting the feet.
• Other Likely Diagnoses
  • Dyshidrotic eczema: Presents with small, itchy blisters on the hands or feet, which can eventually lead to peeling skin and scaly patches.
  • Psoriasis: Can cause scaly patches and may involve the feet, though the presence of holes in the skin surface is less typical.
  • Contact dermatitis: An allergic reaction or irritation causing skin inflammation, which can lead to peeling, scaling, and sometimes macerated areas if the skin is exposed to excessive moisture.
• Do Not Miss Diagnoses
  • Diabetic foot infection: Although less likely, any foot condition in a diabetic patient can quickly become serious. The presence of holes in the skin could indicate ulceration, which is a medical emergency in diabetic patients.
  • Cellulitis: A bacterial skin infection that can cause redness, swelling, and sometimes blistering or peeling of the skin. It requires prompt antibiotic treatment.
• Rare Diagnoses
  • Pitted keratolysis: A bacterial infection causing small holes in the skin of the feet, often associated with excessive sweating.
  • Keratoderma: A group of rare skin conditions that cause thickening of the skin on the palms and soles, which can sometimes lead to peeling and scaling.
  • Erythrasma: A bacterial or fungal infection that affects the folds of the skin, including between the toes, causing maceration, scaling, and sometimes peeling.