II. Definitions
- Tinea Manus (or Tinea Manuum)
- Dermatophyte Infection of hand
- Tinea Pedis
- Dermatophyte Infection of foot
III. Risk Factors
- Heat
- Dampness
- Occlusive shoes
IV. Symptoms (most commonly affects foot)
- Pruritus
- Burning
V. Signs
- General
- Subtypes
- Vesiculobullous lesions
- Involves sole of foot
- Associated with Cellulitis and lymphangitis
- Moccasin (Sandal)
- Diffuse involvement of sole and lateral foot
- Often presents as hyperkeratosis with Scaling of the sole
- Associated with Trichophyton rubrum infection
- May require systemic Antifungal for eradication
- Two foot and one hand disease
- Scaling of 1 hand and 2 feet
- Vesiculobullous lesions
VI. Labs
- Potassium Hydroxide (KOH)
- Culture
- Staphylococcus aerobic coryneforms
- Gram Negative Bacteria
- Resistant fungal organisms suspected
VII. Differential Diagnosis
- See Hand Dermatitis or Foot Dermatitis
- Dyshidrotic Eczema
- Contact Dermatitis
- Atopic Dermatitis
- Reiter's Syndrome
- Psoriasis
- Pustular Psoriasis
- Candidiasis
- Intertrigo
- Erythrasma
- Local callus formation
- Local Bacterial Infection (Cellulitis)
- Staphylococcus aerobic coryneforms
- Gram Negative toe web-space infections (often secondary to Fungal Infection) are similar with exceptions
- More painful
- More likely to extend to the plantar surface
- Pseudomonas Aeruginosa
- Most common of the Gram Negative toe space infections
- Associated with foul smelling, green discharge
- Juvenile plantar dermatosis
- Shiny taut skin of the great toe, ball of the foot and heel
- Spares the web spaces
VIII. Management
- Emphasize Foot care
- Avoid occlusive footwear
- Change to dry socks 2-3 times daily
- Dry between toes twice daily
- Change or alternate shoes
- Control Hyperhidrosis
- Highly absorbent powder (e.g. Zeasorb)
- Drysol (20% aluminum hydroxide) applied bid
- Lazer Formalyde Solution (10% formaldehyde) applied
- Place lamb's wool piece between toes
- Lac-Hydrin cream (for Tinea Manum)
-
Topical Antifungal (twice daily for 3-4 weeks)
- Technique
- Apply to normal skin 2 cm beyond affected area
- Continue for 7 days after symptom resolution
- First line: Imidazoles (e.g. Clotrimazole, OTC)
- Second line: Ciclopirox (Loprox) lotion or cream
- Refractory cases
- Technique
- Systemic Antifungals
- Indicated in severe or refractory cases (not usually needed)
- Agents (dosing listed for adults)
- Terbinafine 250 mg orally once daily for 14 days or
- Fluconazole 150 mg orally once weekly for 3 weeks
- Treat Bacterial superinfection with Antibiotics
- See Complications below
- Non-effective methods
- Avoid daily prophylaxis (not cost effective)
- Avoid Tea tree oil (equivalent to Placebo for cure)
IX. Complications
- ID Reaction
- Secondary Bacterial Cellulitis
X. Prevention
- Avoid walking barefoot in bathrooms and locker rooms
- Keep skin clean and dry