A 43year old male with end-stage renal disease on hemodialysis, peripheral vascular disease, and MRSA bacteremia presented to dermatology as an inpatient consult for a nine-month history of a pruritic eruption on the feet. On physical examination, the patient had marked hyperkeratosis of the bilateral plantar, dorsal, and medial feet (Fig. 1a and b), as well as erythematous, crusted papules of the finger webs, abdomen, penis, and scrotum. Skin scraping revealed the following (Fig. 1c).