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2.1
Tinea Pedis
Athlete's Foot

Images

WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0

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].

Entire Body System

  • Pain

    If this should happen, the rash will become increasingly painful and red. Your foot may become swollen, and you may develop blisters and even open sores in the infected area. [faant.com]

    His condition was getting progressively worse with severe pain on ambulation and pain in all type of shoes, causing him to miss work. [podiatrytoday.com]

    Occasionally, a secondary infection with bacteria in addition to the fungal infection can occur, which can lead to increased redness and pain, as well as spreading of the redness up the foot or leg. [sportsmedtoday.com]

  • Falling

    Washington St., Suite 200, Falls Church, VA 22046, USA Phone 617.948.5100 – Toll free 866.219.3440 Copyright © 2020. All Rights Reserved. Design, CMS, Hosting & Web Development :: ePublishing [centerwatch.com]

    The spots might become crusted over or filled with pus, and the affected hair might fall out. [web.archive.org]

    The spots might become crusted over or filled with pus, and the affected hair might fall out. Next: Learn about people at risk and how to prevent > [cdc.gov]

    Fungi rub off of fingers and bare feet, but also travel on the dead skin cells that continually fall off the body. [en.wikipedia.org]

    Tiny flakes of infected skin may fall off. The rash may spread gradually along the toes if left untreated. In some cases it spreads to the soles. Occasionally, the infection causes a scaling rash on the entire sole and side of the foot. [patient.info]

  • Chronic Infection

    Oral therapy may be required for patients with hyperkerototic soles, severe disease, topical therapy failure, chronic infection or immunosuppression. [mdedge.com]

    Chronic plantar infections are usually caused by T. rubrum and found primarily in patients with an atopic background. [scielo.br]

  • Disability

    As drastic as this procedure might appear, the disability therefrom is far less than that of a severe, unremitting fungal and bacterial infection. [jamanetwork.com]

    Please enable JS and disable any ad blocker [dermatologytimes.com]

    Oral therapy may be required to treat patients with hyperkeratotic soles, disabling or extensive disease, topical therapy failure, chronic infection, or immunosuppression. Surgical therapy is not indicated. [mdedge.com]

  • Chills

    Seek care immediately if: You have a fever or chills. You have red streaks going up your leg. Further information Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. [drugs.com]

    Symptoms include fever, chills, and swollen glands, as well as parts of the body that become swollen, red, and tender. In some cases, cellulitis develops into abscesses and spreads through the body when the blood becomes poisoned with infection. [sterishoe.com]

    She denied fever, chills, malaise, sore throat, oral lesions, nausea, or diarrhea. There was no history of travel outside the United States or contact with anyone who had recently traveled outside the U.S. [omicsonline.org]

    Patients with septicemia have associated signs that include elevated temperatures, chills, hypotension, tachycardia and tachypnea. In chronic paronychia, the skin around the nail becomes pale, red, painful and swollen. [podiatrytoday.com]

Cardiovascular

  • Chest Pain

    Both "chest pain, unspecified" and "other chest pain" saw an increase in total payments in the last 3 years, moving from spots 6 and 10 to spots 3 and 4, respectively. [blog.definitivehc.com]

Musculoskeletal

  • 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]

    Infectious Infection Mycoses Skin Diseases Foot Dermatoses Foot Diseases Pruritus Skin Manifestations Signs and Symptoms [clinicaltrials.gov]

  • Foot Pain

    Insoles, Orthotics and Arch Supports Ready-made insoles are marketed for relief of heel pain, foot pain and back pain. [web.archive.org]

Skin

  • Sweating

    Further, dermcidin concentrations in sweat of tinea pedis patients were found to be lower than those of healthy subjects. These findings suggest a mycostatic role for dermcidin, at normal sweat concentrations. [ncbi.nlm.nih.gov]

    The soles of the feet alone have between 250,000 to 300,000 sweat glands in total. “...the soles of the feet alone have between 250,000 to 300,000 sweat glands in total..” [drpribut.com]

    Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas, such as swimming pools, showers and locker rooms. [foothealthfacts.org]

    Dry your feet thoroughly after sweating, swimming or bathing. Tinea Pedis (Athlete’s Foot) and Fungal Toenail Infections (PDF) HH-I-383 10/15 Copyright 2015, Nationwide Children's Hospital [nationwidechildrens.org]

  • Ulcer

    For people with diabetes, however, the presence of this infection can lead to secondary bacterial infections, foot ulceration, paronychia, cellulitis, osteomyelitis, gangrene and possible lower limb amputation.4-8 Tinea pedis may lead to foot ulceration [podiatrytoday.com]

    Ulcerative The ulcerative type is characterized by pustular eruptions that become ulcers and erosions, especially in between the toes and extending on to the soles of your feet. This is often accompanied by cellulites and skin slough of large areas. [faant.com]

    If the appearance is not diagnostic or if the infection manifests as hyperkeratotic, ulcerative, or vesiculobullous, a potassium hydroxide wet mount is helpful. [msdmanuals.com]

  • Eczema

    Potassium permanganate baths are effective for the treatment of infected eczema when there are blisters, pus and/or oozing. Twice daily baths for two days help to dry out the weeping sores and soothe the eczema. [dermnetnz.org]

    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]

    Some of the other clinical entities to consider include: Dyshidrotic Eczema also known as: pompholyx, vesicular palmoplantar eczema. Original thoughts were that this was a disorder of sweat glands. [drpribut.com]

  • 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]

    Complete cure is defined as negative mycology results (dermatophyte culture and KOH) and the absence of erythema, scaling, and pruritus. [clinicaltrials.gov]

  • Hyperhidrosis

    Detailed anamneses investigated work, life habits, sports and predisposing conditions such as hyperhidrosis and previous pathologies of the feet. [ncbi.nlm.nih.gov]

    Differential diagnosis is sterile maceration (due to hyperhidrosis and occlusive footgear), contact dermatitis (due to type IV delayed hypersensitivity to various materials in shoes, particularly adhesive cement, thiuram compounds in footwear that contains [web.archive.org]

    […] more exposed to the spores at home or during recreational activities, their skin produces less fatty acid (a natural antifungal agent), they wear occlusive footwear, they wear the same pair of socks or shoes for long periods, they sweat excessively (hyperhidrosis [ozarkderm.com]

Psychiatrical

  • Suggestibility

    A meta-analysis of 11 RCTs suggests that allylamines are slightly more effective than azoles. Orally administered antifungal agents are expensive and can have systemic side effects. [mdedge.com]

    We suggest that, despite the low prevalence of this infection in childhood, a potassium hydroxide test and a culture for fungi should always be performed when a child is examined for an inflammatory eruption of the feet. [ncbi.nlm.nih.gov]

Neurologic

  • Burning Sensation

    Many consumers suffer from the discomfort of tinea pedis, whose characteristic symptoms include dry, cracked skin, constant itching, inflammation, scaling, and painful burning sensation. [pharmacytimes.com]

    In more advanced stages, athlete's foot causes a painful, burning sensation. [encyclopedia.com]

    He complained of a mild burning sensation in his toes. Physical examination demonstrated malodorous interdigital lesions that on closer inspection were seen to be exudative erosions (Figure 1). [racgp.org.au]

    The skin may be cracked or scaly with blisters, inflammation and an itching or burning sensation. It may also cover the soles of the feet and involve the toenails. This is called moccasin-type infection. [medsask.usask.ca]

  • Dizziness

    You have an upset stomach or are dizzy. You have questions or concerns about your condition or care. Seek care immediately if: You have a fever or chills. You have red streaks going up your leg. [drugs.com]

    Less frequently reported adverse events were those associated with dizziness, taste disorders, and respiratory infections. Nobody suffered side‐effects that led to any long‐term or lasting damage. [doi.org]

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.

Microbiology

  • Trichophyton Rubrum

    […] interdigitale Tinea pedis due to Trichophyton rubrum Tinea pedis due to Trichophyton violaceum Clinical Information TINEA PEDIS-. dermatological pruritic lesion in the feet caused by trichophyton rubrum t. mentagrophytes or epidermophyton floccosum. [icdlist.com]

    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 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]

    Explore these free sample topics: -- The first section of this topic is shown below -- PATHOGENS Trichophyton rubrum Trichophyton interdigitale Trichophyton mentagrophytes Rare: Epidermophyton floccosum Candida spp. [hopkinsguides.com]

  • Trichophyton Mentagrophytes

    Until now an identification of T. mentagrophytes var. nodulare based on DNA-patterns has not been published. Trichophyton mentagrophytes var. nodulare is supposed to be an anthropophilic dermatophyte causing ordinary tinea and onychomycosis. [ncbi.nlm.nih.gov]

    Furthermore, cotton swabs revealed the presence of Trichophyton mentagrophytes fungus among 63.6% of the swim class students. [sterishoe.com]

    Explore these free sample topics: -- The first section of this topic is shown below -- PATHOGENS Trichophyton rubrum Trichophyton interdigitale Trichophyton mentagrophytes Rare: Epidermophyton floccosum Candida spp. [hopkinsguides.com]

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.

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

  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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