Tinea Pedis

What is Tinea Pedis?

Tinea pedis, more commonly known as athlete’s foot, comes from fungal infections on the skin of the feet. It’s usually caused by specific types of fungi such as Trichophyton rubrum or T mentagrophytes, amongst others. This skin infection typically happens from direct contact with these fungi, which can occur if you’re walking barefoot in communal areas like locker rooms, showers, or pools. People with diabetes and those who wear footwear that doesn’t let their feet breathe are more likely to get athlete’s foot.

Some signs of athlete’s foot include itchy, flaky skin and broken skin between the toes. Some people might also notice areas of thick, hard skin with underlying redness on the inside and outside edges and soles of their feet. Occasionally, people with this condition may develop painful, blister-like sores or have the skin infection spread to their body, nails, or hands.

If left untreated, athlete’s foot could potentially lead to more serious skin issues, like cellulitis, pyoderma (skin infection with pus), and osteomyelitis (bone infection), especially in people with weakened immune systems, diabetes, or poor circulation. In this discussion, we’ll explore why and how athlete’s foot occurs, as well as emphasize the importance of healthcare professionals in diagnosing, treating, and preventing the recurrence and complications of this condition.

What Causes Tinea Pedis?

T rubrum, a type of fungus, is responsible for about 70% of cases of athlete’s foot, also known as tinea pedis. The rest of the cases are mainly caused by two other fungi, T interdigitale and E floccosum. Sometimes, another fungus called Tricholosporum violaceum can also cause athlete’s foot. In the United States, there have been recent cases of athlete’s foot caused by T indotineae, a fungus commonly found in India, Canada, and the Middle East. It’s important to know that T indotineaee is often resistant to usual antifungal treatments. These fungi, known as dermatophytes, love to live in hair, nails, and the outer layer of the skin because these areas are rich in a protein called keratin.

Certain factors can promote the growth of these fungi, including:

* A hot and humid environment
* Wearing tight shoes for a long time
* Sweating a lot
* Being exposed to water for a prolonged period.

Risk Factors and Frequency for Tinea Pedis

Tinea pedis, also known as athlete’s foot, affects about 10% of people. It is more common in adult males than in females. Factors that increase the risk of developing this type of foot fungus include wearing tight-fitting shoes for long periods and using community facilities like public baths, showers, and swimming pools. The average age when people first experience athlete’s foot is 15 years old.

• About 10% of the population may have tinea pedis, or athlete’s foot.
• It’s more common in adult males than in females.
• Wearing tight shoes for a long time can make it more likely to get this fungal infection.
• Using public baths, showers, and pools can also increase the risk.
• Typically, people first get athlete’s foot at around 15 years old.

Signs and Symptoms of Tinea Pedis

Tinea pedis, also known as athlete’s foot, often causes continuous itching in the toe area. People with this issue usually have peeling skin, moist or “macerated” skin, and cracking between the toes. The most impacted parts are usually the base and sides of the toes, which tend to turn red with fine, shiny white scales.

There can also be cases where blistery outbreaks, resembling a condition called pompholyx, appear on the bottom of the foot. However, usually, the persistent inflammation between the toes is the most common symptom.

The more persistent or “moccasin-type” tinea pedis often results in patchy or widespread flaky skin on the bottom and sides of the feet. Some people might experience the vesiculobullous form, most commonly caused by a fungus named T mentagrophytes, which presents as tight blisters or larger fluid-filled lumps on the soles of feet. The burning and itching from these blisters can be particularly uncomfortable. In some cases, an associated bacterial infection can cause a severe form of tinea pedis involving painful ulcers.

Testing for Tinea Pedis

While a physical exam can often suggest a skin infection caused by dermatophytes (a kind of fungus), it’s not always easy to distinguish tinea (the disease these fungi cause) from other skin conditions. Because of this, doctors may need to confirm the diagnosis by visually examining the skin and conducting labs.

For a more detailed examination, your healthcare provider might take a small sample of skin cells from different areas of your body, particularly if you have symptoms in multiple places. This is done mainly by gently scraping off skin flakes with a glass microscope slide. If there are blisters present, the provider will remove the top of the blister and take a sample from the inside.

The sample then undergoes a procedure that involves adding a solution of potassium hydroxide (KOH) – this helps get rid of any non-essential elements and leaves only the fungi behind. A compound called dimethyl sulfoxide (DMSO) might be added as well to speed up this process. The whole mix is then covered with a thin glass cover and checked under a microscope.

Sometimes, a dye like chlorazol black E or toluidine blue might be used to stain the sample, making it easier to see the fungi. They’ll use a special microscope set up that gives a close-up view of the fungi’s structure, including its root-like structures (hyphae) and spores.

While this might sound complex, all these steps are taken to make sure that you get an accurate diagnosis. Once your healthcare provider confirms the presence of tinea, they can decide on the best course of treatment.

Treatment Options for Tinea Pedis

Keeping swimming pools, bathing areas, and changing rooms clean can help prevent the spread of athlete’s foot, also known as tinea pedis. Generally, this skin infection can be managed at home using over-the-counter ointments or creams. In some cases, especially when a bacterial infection is also present, medical treatments like Magenta paint or Castellani paint might be more useful.

There are many effective creams for athlete’s foot that have very low chances of side effects, including clotrimazole, econazole, ketoconazole, miconazole, isoconazole, tioconazole, and sulconazole. However, using terbinafine or amorolfine cream can clear up the infection a bit faster compared to clotrimazole.

In certain cases, especially when the skin has thicken over time – a condition known as hyperkeratosis – the doctor may recommend using a keratolytic like salicylic acid, which helps to shed the outer layer of the skin. After swimming or showering in public areas, using a preventative powder like tolnaftate can help to reduce the incidence of the infection between your toes. While most of these creams or ointments are used for about a month, some patients may see improvements sooner. Terbinafine 1% in particular, can oftentimes show effective results for interdigital tinea pedis – athlete’s foot between the toes – in just a week. Regular follow-ups with your doctor to check the infection with KOH scrapings and cultures is typically recommended.

For those not seeing improvement with these topical treatments, doctors usually recommend a systemic therapy – a treatment that works throughout the body. This could include medications like terbinafine, itraconazole, fluconazole, or griseofulvin. Please note, these systemic therapies are prescribed and dosed by a doctor.

As with any medication, side effects can occur. Fluconazole may cause stomach upsets. Itraconazole can lead to stomach issues, diarrhea, and swelling, especially when taken with certain other medications. Both fluconazole and itraconazole are generally safer for the liver compared to ketoconazole. Terbinafine, on the other hand, could cause stomach disorders and, in rare cases, hepatitis. But remember, these side effects are rare. If you experience any unusual symptoms, make sure to contact your doctor right away.

What else can Tinea Pedis be?

Lesions seen in the condition known as tinea pedis can often look similar to other health issues. This includes:

• Psoriasis
• Keratodermas that are hereditary or developed over time
• Dermatitis that is atopic or contact-based
• Eczema of the palmopustular type
• Pitted keratolysis
• Childhood foot skin condition called juvenile plantar dermatosis
• Keratolysis exfoliativa, which involves the skin peeling off

Also, similar kinds of lesions may appear in the area between the toes. The conditions that may produce such lesions include:

• Psoriasis
• Erythrasma, a type of skin infection
• Infections caused by Candida, a type of yeast

Furthermore, blisters or larger fluid-filled skin lesions may look similar to following conditions:

• Pustular psoriasis
• Dyshidrosis, a skin condition causing small, itchy blisters
• Acute contact dermatitis, a skin reaction to allergens or irritants
• Scabies, a contagious skin condition caused by mites

Another condition known as Reiter syndrome also has lesions that can look similar to those found in tinea pedis.

What to expect with Tinea Pedis

If you’re diligent about prevention, the chances of recovering from tinea pedis, more commonly known as athlete’s foot, are quite good. The risk of getting athlete’s foot increases if you sweat excessively, a condition known as hyperhidrosis. To prevent athlete’s foot, it’s important to dry your feet well, especially between your toes, after you bathe or get them wet. Keeping your feet dry is key to stopping the infection from coming back.

Those who are more likely to get athlete’s foot should wear socks that wick moisture away, use a good quality antifungal powder in their shoes, and put drying foot powders on their feet after washing, again paying special attention to the spaces between the toes. Foot powders containing tolnaftate or clotrimazole are great choices for keeping your feet dry. In some cases, especially when tight, warm footwear is worn, regular use of a topical antifungal cream might be necessary.

Possible Complications When Diagnosed with Tinea Pedis

Most patients suffering from tinea pedis, commonly known as athlete’s foot, don’t experience serious complications. However, untreated cases or cases characterized by persistent skin damage can lead to further health problems.

• Secondary Bacterial Infection: If a severe or extended case of tinea pedis is not properly treated, it might lead to a secondary bacterial infection. A damaged skin barrier allows bacteria to infiltrate, potentially leading to conditions such as the formation of abscesses.
• Impetigo: Tinea pedis can make skin more vulnerable to impetigo, a highly contagious infection. Impetigo appears as crusted lesions that have a honey-like color. These lesions may spread to other parts of the body or to other individuals via direct contact.
• Fungal Nail Infection: If tinea pedis is inadequately managed or left untreated, it can spread to the toenails, causing a condition called onychomycosis. In this case, a fungal organism penetrates the nails, resulting in nails that are thick, discolored, and brittle.
• Cellulitis: In severe cases, tinea pedis might progress to cellulitis, an infection of the foot and leg which manifests as warmth, redness, swelling, and pain in the affected area. This is sometimes accompanied by symptoms that affect the whole body.
• Lymphangitis: Chronic or severe tinea pedis can result in lymphangitis. Signs of this condition are red streaks extending from the infected area and swelling and tenderness of the lymphatic vessels.
• Allergic Contact Dermatitis: Some people might have a local allergic reaction to antifungal medications or other topical treatments used to manage tinea pedis. This can lead to allergic contact dermatitis, characterized by redness, itching, and a rash at the site of application.
• Chronic or Recurrent Infection: Sometimes, tinea pedis might develop into a long-lasting or recurring condition that needs ongoing management and preventive measures. Such persistent infections can significantly affect the individual’s quality of life and overall foot health.

While these complications can be associated with tinea pedis, not all patients will experience them. Getting prompt and suitable treatment, and following preventive measures, can help lessen the risk of complications and contribute to the successful management of tinea pedis.

Preventing Tinea Pedis

Tinea pedis, also known as athlete’s foot, is a type of fungal infection that affects the skin on your feet. People who are most likely to get this infection include those who often have wet feet, those with diabetes, anyone with a weak immune system, and those who wear shoes that don’t allow airflow, such as plastic or rubber shoes. Common places to pick up this infection include public showers, pools, and changing rooms.

People with athlete’s foot often experience itching, flaky skin, and cracks between the toes. In some cases, the skin along the sides and bottom of the foot may thicken and become red. Most people use a specific cream for about a month to treat the infection, although some find they feel better more quickly. If the cream isn’t working, your doctor might recommend taking medication by mouth. There are several steps you can take to avoid getting athlete’s foot again.

Here are some tips to help clear up the infection and prevent it from coming back:

• Wash your feet every day with gentle soap and warm water.
• After washing or getting your feet wet, make sure to dry them completely, especially between the toes.
• Use a separate towel for your feet and don’t let anyone else use it.
• Throw away old shoes that might be infected.
• Choose shoes made of materials that allow air to circulate, like leather or canvas.
• Avoid tight shoes that could make your feet sweaty, as this can encourage fungus to grow.
• Use socks that are designed to pull away moisture to keep your feet dry.
• Wear flip-flops or sandals in public places like pools, gyms, and showers.
• Don’t share shoes, socks, towels, or any personal items with others.
• Check your feet regularly for signs of infection, like redness, itching, or flaky skin.
• Treat any cuts, blisters, or breaks in the skin right away to prevent fungus from getting in.
• Ensure your shoes and socks let air in and out to reduce the risk of getting infected again.
• Keep your feet clean, dry, and taken care of.
• If you have athlete’s foot, tell your family and close friends, and teach them how to prevent getting it.
• Encourage your family to also practice good foot hygiene, to lower the chances of spreading the infection.