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History: The patient is a 30 year old graduate student who presented after vacationing for the summer in Equador. He had developed an itchy rash on both feet (Fig A shows left foot) and right thigh that started prior to his return to the USA. The lesions were continuing to spread.
Physical Examination: The dorsum of his feet showed several erythematous, papular and vesicular, serpiginous lesions. Minimal crusting was present over several toes.
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