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Tinea pedis

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WHAT IS IT?

Abstract

VOL: 100, ISSUE: 30, PAGE NO: 33

 

WHAT IS IT?
- Tinea pedis is commonly referred to as athlete’s foot.

 

 

- It is a common superficial fungal infection of the skin.

 

 

- It is most often caused by Trichophyton rubrum, Trichophyton mentagrophytes or Epidermophyton floccosum.

 

 

- It mainly affects the warm, moist, unventilated areas between the toes.

 

 

- It can vary in severity from mild, chronic and scaling to acute, exfoliative, pustular and bullous.

 

 

SYMPTOMS
- Itching.

 

 

- White scaling of the skin.

 

 

INCIDENCE
- Internationally tinea pedis is thought to be the world’s most common dermatophytosis.

 

 

- 70 per cent of the global population will be infected with tinea pedis at some time.

 

 

- It is no more common in any one racial or ethnic group.

 

 

- It more commonly affects males than females.

 

 

- The prevalence increases with age with most cases occurring after the onset of puberty.

 

 

- Tinea pedis is rare in children.

 

 

DIAGNOSIS
- Diagnosis can be made by visual examination only.

 

 

- In cases where diagnosis is in doubt or treatment has not been effective, a skin scraping may be needed to test for fungus.

 

 

TREATMENT
- Tinea pedis is normally treated with topical antifungal creams.

 

 

- The imidazole antifungals - clotrimazole, econazole, ketoconazole, miconazole, and sulconazole - are all effective.

 

 

- Terbinafine cream is also effective but is more expensive.

 

 

- Application should be in a 4-6cm radius around the affected area as soon as feet begin to itch.

 

 

- Treatment should be continued until two weeks after clearance.

 

 

- Oral antifungal tablets can be prescribed if topical creams are found to be ineffective.

 

 

- Skin scrapings should be examined if systemic therapy is being considered.

 

 

- Antifungal dusting powders are not normally recommended, as they are of little therapeutic value and may cause skin irritation.

 

 

PREDISPOSING FACTORS
- Increased exposure to the spores at home or during recreational activities.

 

 

- Skin that produces less fatty acid, which is a natural antifungal agent.

 

 

- Wearing occlusive footwear.

 

 

- Wearing the same pair of socks or shoes for long periods.

 

 

- Hyperhidrosis (excessive sweating).

 

 

- Immune deficiency, for example due to medications such as azathioprine, or infection with HIV.

 

 

- Poor circulation resulting in cold feet.

 

 

PREVENTION
Patients should be advised on the following preventative information:

 

 

- Wash feet and toes daily;

 

 

- Ensure feet are thoroughly dried after bathing;

 

 

- Keep skin between the toes dry;

 

 

- Use clean towels and do not share them in communal changing rooms;

 

 

- Wash towels frequently;

 

 

- Wear clean socks as fungi may have multiplied in unwashed socks;

 

 

- Wear cotton socks and leather footwear, which can ‘breathe’ and therefore reduce sweating;

 

 

- Do not go barefoot in communal changing rooms;

 

 

- As far as possible go barefoot at home to allow feet to breathe and dry out.

 

 

COMPLICATIONS
- Recurrence is common.

 

 

- Tinea pedis can spread to the hands due to scratching.

 

 

- Secondary infection.

 

 

PATIENT INFORMATION
Patient UK: www.patient.co.uk

 

 

NHS Direct: www.nhsdirect.nhs.uk

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