Tinea Pedis

Aka: Tinea Pedis, Tinea Manum, Tinea Manuum, Tinea Manus, Athlete's Foot

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II. Definitions

  1. Tinea Manus (or Tinea Manuum)
    1. Dermatophyte infection of hand
  2. Tinea Pedis
    1. Dermatophyte infection of foot

III. Risk Factors

  1. Heat
  2. Dampness
  3. Occlusive shoes

IV. Symptoms (most commonly affects foot)

  1. Pruritus
  2. Burning

V. Signs

  1. General
    1. Interdigital maceration at web space
    2. Dry ScalingPlaques
    3. Fissuring
  2. Subtypes
    1. Vesiculobullous lesions
      1. Involves sole of foot
      2. Associated with Cellulitis and lymphangitis
    2. Moccasin (Sandal)
      1. Diffuse involvement of sole and dorsum
      2. Often presents as Scaling of sole
      3. Associated with Trichophyton rubrum infection
      4. May require systemic Antifungal for eradication
    3. Two foot and one hand disease
      1. Scaling of 1 hand and 2 feet

VI. Labs

  1. Potassium Hydroxide (KOH)
  2. Culture
    1. Staphylococcus aerobic coryneforms
    2. Gram Negative Bacteria

VII. Differential Diagnosis

  1. See Hand Dermatitis or Foot Dermatitis
  2. Dyshidrotic Eczema
  3. Contact Dermatitis
  4. Atopic Dermatitis
  5. Reiter's Syndrome
  6. Psoriasis
  7. Pustular Psoriasis
  8. Candidiasis
  9. Intertrigo
  10. Erythrasma
  11. Local Bacterial Infection (Cellulitis)
  12. Local callus formation
  13. Juvenile plantar dermatosis
    1. Shiny taut skin of the great toe, ball of the foot and heel
    2. Spares the web spaces

VIII. Management

  1. Emphasize Foot care
    1. Avoid occlusive footwear
    2. Change to dry socks 2-3 times daily
    3. Dry between toes twice daily
    4. Change or alternate shoes
  2. Control Hyperhidrosis
    1. Highly absorbent powder (e.g. Zeasorb)
    2. Drysol (20% aluminum hydroxide) applied bid
    3. Lazer Formalyde Solution (10% formaldehyde) applied
    4. Place lamb's wool piece between toes
  3. Lac-Hydrin cream (for Tinea Manum)
  4. Topical Antifungal (twice daily for 3-4 weeks)
    1. Technique
      1. Apply to normal skin 2 cm beyond affected area
      2. Continue for 7 days after symptom resolution
    2. First line: Imidazoles (e.g. Clotrimazole, OTC)
    3. Second line: Ciclopirox (Loprox) lotion or cream
    4. Refractory cases: Naftin, Lamisil, Mentax
  5. Systemic Antifungals
    1. Indicated in severe or refractory cases (not usually needed)
    2. Agents (dosing listed for adults)
      1. Terbinafine 250 mg orally once daily for 14 days or
      2. Fluconazole 150 mg orally once weekly for 3 weeks
  6. Treat Bacterial superinfection with Antibiotics
    1. See Complications below
  7. Non-effective methods
    1. Avoid daily prophylaxis (not cost effective)
    2. Avoid Tea tree oil (equivalent to Placebo for cure)

IX. Complications

  1. ID Reaction
  2. Secondary Bacterial Cellulitis
    1. See Tinea Pedis Superinfection

X. Prevention

  1. Avoid walking barefoot in bathrooms and locker rooms
  2. Keep skin clean and dry

XI. References

  1. Andrews (2008) Am Fam Physician 77(10): 1415-20 [PubMed]
  2. Schwartz (2004) Lancet 364(9440):1173-82 [PubMed]
  3. Evans (1993) BMJ 307:645-7 [PubMed]
  4. Tong (1992) Australas J Dermatol 33:145-9 [PubMed]

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