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This column is aimed at developing your clinical acumen. A clinical quiz will alternate with a short discussion of a clinical sign. You are invited to send us requests for future topics and to provide photographs of clinical signs for the quiz section. Kindly send a fax or e-mail with your requests and mail high gloss photographs or a disk with high resolution (300dpi) jpeg files to us. (See contact details above) Photographs may include clinical signs, photographs of poisonous insects, plants, snakes, contaminated water or anything that may cause sickness or disease in South Africa. Kindly provide a short clinical synopsis of 100-200 words from which a quiz can be formulated. This intensely itchy lesion appeared on a 65 year old patient's toe, six days after spending a week on the golden beaches of neighbouring Mozambique. What may be the cause? Unlikely causes: • Ingrowing toe nail (septic paronychium)? Big toe usually affected.

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