“His feet stink, the cream from the chemist hasn’t worked, and he won’t listen to a word I say”

A skin complaint can be a young person’s ticket of entry. Tinea pedis is common and easy to treat: interdigital itch, maceration, scaling and fissuring, usually between the 4th and 5th toes. NICE CKS recommends a topical antifungal (for example terbinafine for 1–2 weeks or an imidazole for several weeks, depending on the product; check the SPC/local formulary) plus foot hygiene: dry between the toes, change socks daily, alternate footwear, and do not share towels. Most “treatment failures” are short or irregular use. Oral antifungals are not needed for uncomplicated interdigital infection. The real station is the cue: a 16-year-old who has stopped washing, games through the night, has quit his team and will not look at the camera. Self-neglect and withdrawal should prompt a psychosocial history. See the young person alone for part of the consultation, explain confidentiality and its limits, and use a HEADSS framework. Ask directly about suicidal thoughts, plans, self-harm, protective factors and access to means; asking does not increase risk. NICE NG134 (Depression in children and young people) supports watchful waiting, then psychological therapy such as digital CBT, group or individual CBT, with referral to CAMHS for moderate to severe depression or risk. Bullying, including online, should be addressed with the school with the young person’s agreement. Agree with him what will be shared with his parent, and give a safety plan and crisis contacts. A 16-year-old is presumed to have capacity to consent, and his confidentiality should be respected unless there is a serious risk of harm (GMC 0–18 years guidance).