Dry soles

25 y, white man, presents to the office with excessively dry soles, a problem for the past 7 years. He complains of excessive sweating restricted to his feet. It seems to impair is daily activities and sometimes needs to change his socks several times in the course of a day. He acknowledges exacerbation of his symptoms in stressful situations and in summer. He denies nocturnal sweats, fever, cough, anorexia, wt loss, skin rash, arthralgias, anxiety or depression. He denies travel or exposure to new chemicals. None of the over the counter remedies seem to help. He has seen multiple physicians for the problem with no avail. He does not take any medications. On exam, his vital signs are stable. He has excessively dry and macerated soles. No involvement of palms or axillae is noted. What is the most likely diagnosis?

1. Icthyosis
2. Tylosis
3. Bazex’s syndrome
4. Focal hyperhidrosis- ANSWER
5. Undiagnosed anxiety disorder
6. Hyperthyroidism