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Tinea Pedis (Athlete's Foot)

By

Denise M. Aaron

, MD, Dartmouth-Hitchcock Medical Center

Last full review/revision Sep 2021| Content last modified Sep 2021
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Tinea pedis is a dermatophyte infection of the feet. Diagnosis is by clinical appearance and sometimes by potassium hydroxide wet mount, particularly if the infection manifests as hyperkeratotic, ulcerative, or vesiculobullous or is not interdigital. Treatment is with topical antifungals, occasionally oral antifungals, moisture reduction, and drying agents.

Tinea pedis is the most common dermatophytosis Overview of Dermatophytoses Dermatophytoses are fungal infections of keratin in the skin and nails (nail infection is called tinea unguium or onychomycosis). Symptoms and signs vary by site of infection. Diagnosis is by... read more because moisture resulting from foot sweating facilitates fungal growth. Tinea pedis may occur as any of 4 clinical forms or in combination:

  • Chronic hyperkeratotic

  • Chronic intertriginous

  • Acute ulcerative

  • Vesiculobullous

Chronic hyperkeratotic tinea pedis due to Trichophyton rubrum causes a distinctive pattern of lesion, manifesting as scaling and thickening of the soles, which often extends beyond the plantar surface in a moccasin distribution. Patients who are not responding as expected to antifungal therapy may have another less common cause of plantar rash. Differential diagnosis is sterile maceration (due to hyperhidrosis and occlusive footgear), contact dermatitis Contact Dermatitis Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Symptoms include pruritus and... read more Contact Dermatitis (due to type IV delayed hypersensitivity to various materials in shoes, particularly adhesive cement, thiuram compounds in footwear that contains rubber, and chromate tanning agents used in leather footwear), irritant contact dermatitis Irritant contact dermatitis (ICD) Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Symptoms include pruritus and... read more Irritant contact dermatitis (ICD) , and psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including... read more Psoriasis .

Manifestations of Tinea Pedis

Chronic intertriginous tinea pedis is characterized by scaling, erythema, and erosion of the interdigital and subdigital skin of the feet, most commonly affecting the lateral 3 toes.

Acute ulcerative tinea pedis (most often caused by T. mentagrophytes var. interdigitale) typically begins in the 3rd and 4th interdigital spaces and extends to the lateral dorsum and/or the plantar surface of the arch. These toe web lesions are usually macerated and have scaling borders. Secondary bacterial infection, cellulitis, and lymphangitis are common complications.

Vesiculobullous tinea pedis, in which vesicles develop on the soles and coalesce into bullae, is the less common result of a flare-up of interdigital tinea pedis; risk factors are occlusive shoes and environmental heat and humidity.

Diagnosis of Tinea Pedis

Treatment of Tinea Pedis

  • Topical and occasionally oral antifungals

  • Moisture reduction and drying agents

The safest tinea pedis treatment is topical antifungals, but recurrence is common and treatment must often be prolonged. Alternatives that provide a more durable response include itraconazole 200 mg orally once a day for 1 month (or pulse therapy with 200 mg 2 times a day 1 week/month for 1 to 2 months) and terbinafine 250 mg orally once a day for 2 to 6 weeks. Concomitant topical antifungal use may reduce recurrences.

Moisture reduction on the feet and in footwear is necessary for preventing recurrence. Permeable or open-toe footwear and sock changes are important especially during warm weather. Interdigital spaces should be manually dried after bathing. Drying agents are also recommended; options include antifungal powders (eg, miconazole), gentian violet, Burow solution (5% aluminum subacetate) soaks, and 20 to 25% aluminum chloride solution nightly for 1 week then 1 to 2 times/week as needed.

Key Points

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