Tinea Pedis, Athlete's Foot, Foot Fungus. Here's what you need to know.

TBS Health
Tinea Pedis, Athlete's Foot, Foot Fungus. Here's what you need to know.

In this article we will be covering: Who gets tinea, what the clinical features of tinea are, how tinea is diagnosed and how it is managed.

What is tinea pedis?

Tinea pedis usually occurs in males and adolescents/young adults, but can also affect females, children and older people. Infection is usually acquired by direct contact with the causative organism, for example using a shared towel, or by walking barefoot in a public change room. Other risk factors for tinea include excessive sweating, occlusive footwear (for example, heavy industrial boots),  underlying immunodifiency and poor peripheral circulation.

    What are the clinical features of tinea pedis?

    There are usually three main ways that tinea can present: 

    • Itchy erosions and/or scales between the toes, especially between 4th and 5th toes
    • Scale covering the sole and sides of the feet (hyperkeratotic/moccasin type, usually caused by T. rubrum)
    • Small to medium-sized blisters, usually affecting the inner aspect of the foot (vesiculobullous type).
    • It can also uncommonly cause oozing and ulceration between the toes (ulcerative type), or pustules (these are more common in tinea pedis due to T. interdigitale than that due to T. rubrum).

    How is the diagnosis of tinea pedis made?

    The diagnosis of tinea pedis can be made clinically by examining the characteristic and clinical features, or by scraping and examining the skin under a microscope done by a pathology lab.

    What are the clinical feature of tinea pedis?

    Tinea pedis tends to be asymmetrical, and may be unilateral. It usually presents in one of three ways:

    1. Scaly and itchy erosions between the toes, which can usually be found between the 4th and 5th toes.

    2. Small to medium-sized blisters, usually affecting the inner aspect of the foot 

    3. Scales covering the sole and sides of the feet

    How is Tinea managed?

    Prevention

    General measures should be the first line of defense against athlete's foot. These include drying off your feet thoroughly, especially between the toes, avoiding wearing socks with tight-fitting shoes, and using sandals in communal showers. Other ways of preventing tinea pedis may include:

    • Dry feet and toes thoroughly after bathing
    • Avoid wearing occlusive footwear for long periods
    • Avoid sharing footwear especially sneakers
    • Thoroughly dry shoes and boots
    • Treat shoes with antifungal powder.

    Treatment

    Topical antifungal treatments should be applied once or twice daily for 2 to 4 weeks. These include azoles (e.g., miconazole), allylamines (e.g., terbinafine), butenafine, ciclopirox, and tolnaftate. Single-dose regimes can be successful for mild infections.

    For those who do not respond to topical antifungal treatments, oral antifungal agents may be needed for a few weeks. These include:

    • Terbinafine
    • Itraconazole
    • Fluconazole
    • Griseofulvin

    A topical keratolytic cream containing salicylic acid and urea may be beneficial in treating hyperkeratotic variants of tinea pedis.