Fungus

Tinea Pedis

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Tinea Pedis, Tinea Manum, Athlete's Foot

  • Definitions
  1. Tinea Manum: Dermatophyte infection of hand
  2. Tinea Pedis: Dermatophyte infection of foot
  • Predisposing factors
  1. Heat
  2. Dampness
  3. Occlusive shoes
  • Symptoms (most commonly affects foot)
  1. Pruritus
  2. Burning
  • 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
  • Labs
  • 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. Candidiasis
  8. Intertrigo
  9. Erythrasma
  10. Local Bacterial Infection (Cellulitis)
  11. Local callus formation
  12. Juvenile plantar dermatosis
    1. Shiny taut skin of the great toe, ball of the foot and heel
    2. Spares the web spaces
  • 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. Drysol (20% aluminum hydroxide) applied bid
    2. Lazer Formalyde Solution (10% formaldehyde) applied
    3. 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)