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Tinea Pedis

Athlete Foot


Presentation

The Tinea pedis infection usually starts as reddish rash in the interdigital area of the foot with predilection to the fourth and fifth digits of the toes. The rash will start to scale and form fissuring of the skin forming linear wound which may be painful with pruritus (burning and itching sensation) [4].

Chronically, scaling may evolve to maceration of the local tissue exuding a foul smelling odor from the wound. At this point, secondary bacterial infections of the skin may set in. Variants presenting with pustule and vesicles may also present during the erythematous stage of the disease. Toe nails may discolor and deform in the affected digit where it is observably brittle to manipulate.

Although the term “Pedis” refers exclusively to the foot, the fungus causing Tinea pedis like Trichophyton rubrum may affect other parts of the body like the fingers, fingernails, palm of the hands and groins. The clinical presentation in the other parts of the body is very similar to the toe afflictions [10].

Plethora
  • Given the lack of a standard method for Malassezia susceptibility testing and the plethora of published methods, we also developed an improved method for this genus.[ncbi.nlm.nih.gov]
Venous Insufficiency
  • Part 2: Dermatophytes, chronic venous insufficiency, photoprotection, actinic keratoses, vitiligo, hair loss, cosmetic indications , JDDG: Journal der Deutschen Dermatologischen Gesellschaft , 8 , 11 , (866-873) , (2010) . Jenny M.[doi.org]
Foot Disease
  • From Wikidata Jump to navigation Jump to search Foot disease Dermatophytosis of foot Dermatophytosis of foot (& tinea pedis) Dermatophytosis of foot (disorder) Tinea pedis Tinea pedis (disorder) ringworm of foot athlete's foot pes dermatophytosis edit[wikidata.org]
  • Aus Wikimedia Commons, dem freien Medienarchiv Zur Navigation springen Zur Suche springen Fußpilz Krankheit Medium hochladen Wikipedia Ist ein(e) Krankheit, Infektionskrankheit Unterklasse von Dermatophytose, foot disease, Hautkrankheit Normdatei Q5609817[commons.wikimedia.org]
  • .: fungal infection athlete foot Additional relevant MeSH terms: Layout table for MeSH terms Tinea Tinea Pedis Dermatomycoses Skin Diseases, Infectious Infection Mycoses Skin Diseases Foot Dermatoses Foot Diseases Pruritus Skin Manifestations Signs and[clinicaltrials.gov]
  • Diseases Pruritus Skin Manifestations Signs and Symptoms[clinicaltrials.gov]
  • Diseases Pruritus Skin Manifestations Signs and Symptoms Terbinafine Antifungal Agents Anti-Infective Agents Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action[clinicaltrials.gov]
Eczema
  • Some cases do not respond to treatment for tinea or eczema. METHODS: Patients with foot intertrigo with a poor response to antifungal or antiinflammatory treatment from 2004 to 2009 were included in this study.[ncbi.nlm.nih.gov]
  • Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease.[ncbi.nlm.nih.gov]
  • This type of athlete’s foot is often seen in people with eczema or asthma. It is associated with fungal nail infections which may lead to recurrent skin infections.[web.archive.org]
  • This type of athlete’s foot is often seen in people who have eczema or asthma. It is associated with fungal nail infections which may lead to recurrent skin infections.[dermatology.about.com]
  • Differentiation from psoriasis or eczema may be difficult. Exposure to a moist environment, trauma, occlusive footwear, and regular user of public showers and pools acts as predisposing factors for developing the disease (3).[gpnotebook.co.uk]
Pruritus
  • Improvements in patient quality of life (pruritus) and patient preference were measured using the pruritus visual analog scale (VAS), Skindex-16, and patient preference questionnaires.[ncbi.nlm.nih.gov]
  • Patients showed rapid improvement in pruritus as early as week 2, and at six weeks' follow up, all patients were free of erythema while 93.8 percent were free of pruritus; no relapses had occurred.[ncbi.nlm.nih.gov]
  • The pruritus visual analog scale (VAS) was used to assess the subjective symptom of itching.[ncbi.nlm.nih.gov]
  • All 1174 subjects with interdigital presentation satisfied the inclusion criteria of a minimum of moderate erythema and scaling, and mild pruritus.[ncbi.nlm.nih.gov]
  • Here we report on a 60-year-old patient with diabetes presenting with pain, severe pruritus, and malodour in the foot's interdigital area, and subsequently, diagnosed with inflammatory tinea pedis with bacterial superinfection.[ncbi.nlm.nih.gov]
Foot Rash
  • Rather, it's an allergic response to the original foot rash. An id reaction will clear on its own once the original athlete's foot resolves.[verywellhealth.com]
  • Although a variety of fungi can cause foot rashes, Trichophyton mentagrophytes cause the itchy, cracked skin typically found between the fourth and fifth toes.[diseasesdic.com]
Plantar Hyperkeratosis
  • The major clinical forms of tinea pedis are: 1) intertriginous; 2) plantar hyperkeratosis and 3) vesiculo-bullous infections 2.[scielo.br]

Workup

A detailed medical history of the clinical course of the disease may easily clinch the suspicion of tinea pedis in patients. The characteristic lesion seen by the physician may herald the Trichophyton’s presence in the affected area of the foot. In this classical scenario, the physician may opt to proceed in treating the disease while waiting for confirmatory tests.

In cases where laboratory confirmation is required, skin scrapings may be taken and drenched in KOH (Potassium Hydroxide) and examined in under the microscope where the fungal mycelia and spores are seen under the magnifications.

The exposure of the foot to a black light or Wood’s light may reveal fluorescent greenish hue which is characteristic of erythrasma bacterial infection which usually coexist with Trichophyton infection. When these tests become inconclusive, samples from the lesions may be taken for culture to identify the pathogen.

Trichophyton Rubrum
  • Cultures were negative for bacteria, but grew Trichophyton rubrum.[ncbi.nlm.nih.gov]
  • We report here two cases of bullous tinea pedis, one due to Trichophyton rubrum in a 6-year-old child and the second due to T. interdigitale in a 10-year-old child.[ncbi.nlm.nih.gov]
  • The clinical picture is one of chronic, hyperkeratotic, recalcitrant tinea pedis similar to that caused by Trichophyton rubrum. Except for 2 years in Alaska, our 46-year-old patient had never lived outside the state of Louisiana.[ncbi.nlm.nih.gov]
  • Previously, we demonstrated the efficacy of ozone in killing ATCC strains of the dermatophyte fungi Trichophyton rubrum and Trichophyton mentagrophytes.[ncbi.nlm.nih.gov]
  • The Jock Itch or Tinea cruris in the groin area may also develop for it is also caused by the same fungus, Trichophyton rubrum.[symptoma.com]
Trichophyton Mentagrophytes
  • Trichophyton mentagrophytes var. nodulare is supposed to be an anthropophilic dermatophyte causing ordinary tinea and onychomycosis. The low number of reports indicates that it is a very rare variety.[ncbi.nlm.nih.gov]
  • The predominant etiologic agents in feet were Trichophyton rubrum 8 (36%), Trichophyton mentagrophytes 1 (4%), Rhodotorula 8 (36%), Trichosporon 2 (9%), Candida glabrata 2 (9%), Candida albicans 1 (4%), while Trichophyton verrucosum 8 (88%) and Trichophyton[ncbi.nlm.nih.gov]
  • Trichophyton mentagrophytes was later identified in repeated cultures.[ncbi.nlm.nih.gov]
  • Previously, we demonstrated the efficacy of ozone in killing ATCC strains of the dermatophyte fungi Trichophyton rubrum and Trichophyton mentagrophytes.[ncbi.nlm.nih.gov]
  • AIMS: To test a nitric oxide-releasing solution (NORS) as a potential antifungal footbath therapy against Trichophyton mentagrophytes and Trichophyton rubrum during the mycelial and conidial phases.[ncbi.nlm.nih.gov]

Treatment

Tinea Pedis in its mild form may only require topical antifungal treatment in the form of creams, ointment, gels and spray which may take a month of continuous treatment applied twice daily [3].

Severe cases may need oral or parenteral antifungals to augment the topical agents. Toe nails removal may be required if observable secondary bacterial infection is widespread and toe nail is no longer salvageable [6].

Prognosis

With adequate antifungal therapy and foot care, Tinea pedis carries a very good prognosis. Untreated cases of Trichophyton infection may eliminate the helpful resident bacteria of the skin and cause an overgrowth of harmful bacteria that may cause a more dangerous secondary infection like cellulitis [8]. It is to be expected that cases of Tinea pedis may recur regularly even after treatment.

Complications

Tinea pedis is fairly contagious thus other parts of the body may be affected. Scratching the itch in the toes may infect the fingernails in the same way and while it is scratched to other body parts, fungal spores may be deposited in the stratum corneum in other areas resulting to a new infection [5].

The Jock Itch or Tinea cruris in the groin area may also develop for it is also caused by the same fungus, Trichophyton rubrum. The imbalance of bacterial and fungal flora may cause other infections to thrive in the affected organ like cellulitis, pyoderma and necrosis making it more difficult to treat [7].

Etiology

Tinea pedis is caused by a fungus known as Trichophyton which are dermatophytes that inhabit the stratum corneum – the dead layer of the skin and nails.

It is a normal resident flora of the skin which are opportunistic in nature, waiting for the right suitable conditions like warm and moist skin like the skin in between the toes before it blooms into a fungal infection [2]. The most common species for Tinea pedis is Trichophyton rubra in more than 70% of the cases and less commonly by Trichophyton tonsurans, Trichophyton mantagrophytes, and Microsporum canis.

Epidemiology

The term Athlete’s foot was coined because the disorder is more prevalent in this type of group class. It is contagious with infected fomites like towels and tubs while it can also be acquired from communal baths, steam rooms, gym, swimming pools and sports clubs. These are the kind of places athletes would frequent [9].

There is a slight preponderance of the disease in males than in females. Footwear use greatly influence the spread of the infection were it favors closed and tight footwear because of high humidity and warmth, while walking on sandals or barefoot may allow the outer layer of the skin to dry up fast and inhibit the fungal growth. Pet handlers may acquire the affliction from infected canines (M. canis) in less than 10% of cases, dogs harbor the fungus in their furs increasing prevalence to humans with increased human to animal interactions.

Sex distribution
Age distribution

Pathophysiology

The Trichophyton infection in Tinea pedis or Athlete’s foot is basically an opportunistic affliction caused by the imbalance of the normal flora. The warm and humid environment is the intertriginous (in between toes) areas of the skin triggers the overgrowth of the Trichophyton overwhelming the other limiting the growth of other organism.

This mycosis that thrives in the dead layer of the skin may also affect the toenails. The crusting formation in the keratinized nail bed causes it to discolor or and become brittle. The incrusting and the epidermal invasion of the fungus beyond the stratum corneum layer causes irritation and itching to the skin. The typical reddish discoloration of inflammation in skin is mostly observable in Trichophyton rubrum infection.

Prevention

It is imperative to keep our feet dry all the time to prevent fungal growth. Footwear should not be too tight and must be ventilated to avert humidity build up. Foot powder with antifungal properties may benefit the foot. Wearing of socks may prevent over sweating of the foot especially in long runs or walks. Shoe sharing is oftentimes discourage to keep the spread of infection.

Summary

Tinea pedis or more commonly known as “Athlete’s foot” is scaly and itchy rash in the foot that usually begins in the toes. This is particularly common in athletes because it usually thrives in wet and sweaty foot enclosed in clothing like socks [1].

Tinea pedis is a recurring disease that is fungal in nature and is easily treated with topical antifungal ointments. This fungal species is closely related to other fungal infections like tinea cruris, tinea circinata and tinea flava.

Patient Information

People should always protect their foot especially in public baths or public swimming pools where transmission of the disease is frequently noted. When the early signs are noticed in the foot, medical attention must be sought to prevent the spread of the disease.

Those individuals with on-going infection should exert all efforts to avoid spreading the disease by prudently isolating infection by not sharing fomites and shoes to others.

References

Article

  1. Lopez-Martinez R, Manzano-Gayosso P, Hernandez-Hernandez F, Bazan-Mora E, Mendez-Tovar LJ. Dynamics of dermatophytosis frequency in Mexico: an analysis of 2084 cases. Med Mycol. Nov 3 2009;
  2. Gentles JC. The isolation of dermatophytes from the floors of communal bathing places. J Clin Pathol. Nov 1956;9(4):374-7
  3. Weinberg JM, Koestenblatt EK. Treatment of interdigital tinea pedis: once-daily therapy with sertaconazole nitrate. J Drugs Dermatol. Oct 1 2011;10(10):1135-40.
  4. Pellizzari C. Recherche sur Trichophyton tonsurans. G Ital Mal Veneree. 1888;29:8.
  5. Gupta AK, Cvetkovic D, Abramovits W, Vincent KD. LUZU (luliconazole) 1% cream. Skinmed. Mar-Apr 2014;12(2):90-3
  6. Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res. Dec 4 2011;4:26.
  7. Gul U, Cakmak SK, Ozel S, Bingol P, Kaya K. Skin disorders in patients with hemiplegia and papaplegia.J Rehabil Med. Jul 2009;41(8):681-3
  8. Frykberg RG, Zgonis T, Armstrong DG, et al. American College of Foot and Ankle Surgeons. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. Sep-Oct 2006;45(5):S2-66.
  9. Elewski BE. Tinea pedis and tinea manuum. In: Demis DJ. Clinical Dermatology. Vol 3. Philadelphia, Pa: Lippincott; 1999:Unit 17-9; 1-11
  10. Freedberg IM, Eisen AZ, Wolff K, et al. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:2349-51

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Last updated: 2019-07-11 22:29