Updated: 3/13/2018

Tinea Pedis / Manuum

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Snapshot
  • A 50-year-old man presents to his primary care physician's office for a rash on his right foot. He reports that he has had this rash for several months intermittently. He also says the rash is associated with occasional itchiness and a burning sensation. He admits that he often wears heavy-duty boots because of his profession as a construction worker, and he does not take them off until bedtime. On physical exam, there is diffuse erythema and thick scaling over the plantar surface and macerations in the space between the toes. He is prescribed an antifungal topical cream.
Introduction
  • Clinical definition
    • a dermatophytosis
      • tinea pedis
        • superficial fungal skin infection of the foot
        • also known as athlete’s foot
      • tinea manuum
        • superficial fungal skin infection of the hand
  • Epidemiology
    • prevalence
      • 2.9% prevalence
    • demographics
      • adults > children
      • males > females
    • risk factors
      • moist and warm environment
      • occlusive footwear
      • soldiers
      • hyperhidrosis
      • broken skin
      • walking barefoot
  • Etiology
    • dermatophytes
      • Trichophyton
        • most commonly Trichophyton rubrum and Trichophyton interdigitale
      • Microsporum
      • Epidermophyton
  • Pathogenesis
    • fungus infects superficial keratinized tissue
      • limited to stratum corneum, hair, or nails
    • dermatophytes require keratin to grow
  • Associated conditions
    • tinea cruris
    • onychomycosis
  • Prognosis
    • responsive to topical treatment
Presentation
  • Symptoms
    • primary symptoms
      • itch
      • burning
      • especially between the toes or fingers
      • sloughing of skin on feet
  • Physical exam
    • erythema and overlying scaling
    • fissures and macerations, especially of the feet
      • typically in interdigital spaces and plantar surface
    • vesicles may also be seen
Studies
  • KOH preparation
    • skin scrapings at active edge of lesion mixed with KOH
    • presence of septated hyphae and spores indicates fungal infection
  • Diagnostic criteria
    • diagnosis usually based on clinical history and physical exam
Differential
  • Contact dermatitis
  • Psoriasis
Treatment
  • Medical
    • topical therapy
      • indication
        • localized lesions
      • drugs
        • terbinafine 1%
          • approved for patients 12 years of age and older
        • clotrimazole 1%
          • approved for patients 2 years of age and older
        • ketoconazole 2%
    • oral therapy
      • indications
        • widespread disease
        • concomitant onychomycosis
      • drugs
        • terbinafine
        • itraconazole
Complications
  • Id reaction (dermatophytid reaction)
    • secondary immunological reaction at a separate site on the skin caused by activated circulating antibodies or activated T-cells
  • Secondary bacterial infection

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