Tinea Pedis

Summary

  • Dermatophyte infection of the feet
  • Commonly Trichophyton rubrum, Trichophyton mentagrophytes (interdigitale), Epidermophyton floccosum
  • Non-dermatophyte moulds such as Candida may be secondary infections

 

Diagnostic tips

  • Presentation may be asymptomatic, but is commonly pruritic, with blisters, scaling and fissuring.
  • Tinea Pedis may be classified as
    • Interdigital – between the toes and extending onto the plantar surface
    • Chronic Hyperkeratotic – moccasin distribution with plantar erythema, scaling, and hyperkeratosis
    • Infammatory/vesicular – painful pruritic vesicles with erythema and can be complicated by secondary bacterial infection
    • Ulcerative – rapidly spreading erosive lesions with secondary bacterial infection, common in immunocompromised patients.
  • More common in men. Unusual in children.

Tests and Imaging

  • Microscopy and culture of skin scrapings or de-roofed vesicles.
  • Adequate sample size is essential for accurate analysis.
  • Swab for secondary bacterial infection

Immediate Treatment

  • Application of topical antifungal agents, or combination therapies with hydrocortisone 1%
  • Oral terbinafine, itraconazole, or fluconazole may be indicated for severe cases
  • Use of antiperspirant may help with hyperhidrosis
  • Cease use of occlusive footwear

 

Possible Referral

  • Podiatry for expert debridement and advice on disinfection of footwear and hosiery
  • Podiatry for management of hyperkeratosis and hyperhidrosis.
  • Dermatologist for inflammatory or ulcerative cases.

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