Tinea Pedis Infection (Athlete's Foot) - Causes, Types, Signs & Symptoms, And Treatment
Tinea pedis is a dermatophyte infection of the soles and the interdigital spaces of the feet.
The most common organism causing tinea pedis infection is the fungus Trichophyton rubrum.
In addition, other organisms like Trichophyton mentagrophytes, and Epidermophyton floccosum can also cause the disease.
Non-dermatophyte causes include Scytalidium dimidiatum, Scytalidium hyalinum, and, rarely, Candida species.
These organisms invade the superficial keratin layer of the skin using their keratinase enzymes.
Their cell walls contain mannans, which inhibit the body’s immune response against dermatophytes.
Their growth is inhibited by sebum, thus, there is a propensity for dermatophyte infection of the feet, which have no sebaceous glands.
Tinea pedis more commonly affects males compared with females.
Immunosuppressive therapy and diabetes mellitus increase the risk of tinea pedis infection.
Most patients present with redness, fissuring, and scaling in the interdigital spaces of the feet, especially between the 4th and 5th toes.
It is often associated with intense itching.
Sometimes, the fungal infection is subsequently followed by secondary bacterial infection.
Commonly, tinea pedis patients describe pruritic, scaly soles and, often, painful fissures between the toes.
Less often, patients describe vesicular or ulcerative lesions. Some tinea pedis patients, especially elderly persons, may simply attribute their scaling feet to dry skin.
Chronic hyperkeratotic tinea pedis is characterized by chronic plantar erythema with slight scaling to diffuse hyperkeratosis.
It can be asymptomatic or pruritic.
Both feet are usually affected, and in severe cases, the condition may extend to the dorsal aspect of the foot.
Typically, the dorsal surface of the foot is clear, but, in severe cases, the condition may extend onto the sides of the foot.
In some individuals, painful, pruritic vesicles or bullae, may be seen.
The lesions contain clear or yellowish fluid, which leave erythema and pruritis after they rupture.
This type of tinea infection can be complicated with cellulitis.
The other type, the ulcerative variety is characterized by rapidly spreading vesiculopustular lesions, ulcers, and erosions, typically in the web spaces, and is often accompanied by a secondary bacterial infection.
In immunocompromised or diabetic individuals, sloughing of larger areas may be seen.
Tinea pedis can be treated with topical or oral antifungals or a combination of both.
Commonly used topical agents include imidazoles such as clotrimazole, econazole, ketoconazole, and miconazole.
Pyridones such as ciclopirox.
Allylamines such as naftifine and terbinafine.
And topical benzylamines such as butenafine.
Commonly used oral agents include itraconazole, terbinafine, and fluconazole.
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