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Tinea Pedis

Updated : March 11, 2024





Background

A dermatophyte fungus infection of the feet known as tinea pedis or foot worm affects the soles and interdigitates clefts of the nails, and toes. Athlete’s foot is another name for it.

Trichophyton rubrum, a dermatophyte that was historically endemic to various regions of Africa, Asia, and Australia, is the culprit behind the infection. Today, though, the organism is still present throughout the Americas and Europe.

Epidemiology

Dermatophyte infections of the leg clefts may afflict ten percent of the general population. It is primarily blamed on wearing occlusive footwear for extended periods of time.

As the occurrence of tinea pedis is seen to be greater in patients using community baths, pools, and showers using sanitation facilities is likely to raise the odds of infection. Adult males are more likely than females to have the disease. One study found that the average age of onset was fifteen years.

Anatomy

Pathophysiology

Tinea pedis infection is likely caused by the blockage of foot clefts, maceration, and damp environments together with a growth in the microflora. This illness is influenced by skin deterioration, temperature, and humidity.

The fungus invaded the skin’s keratin layer by releasing keratinase enzymes. Additionally, mannans, which block the body’s immunological response, are found in the cell walls of dermatophytes.

Etiology

Trichophyton rubrum primarily causes tinea pedis. Additionally engaged are Epidermophyton floccosum and Trichophyton interdigitale. Tricholosporum violaceum is another sporadic agent. About 70% of the cases are caused by T. rubrum.

Risk elements consist of

  • a warm, muggy climate
  • Wearing occlusive shoes for a long time
  • Overly sweaty
  • Prolonged contact with water

Etiology

Genetics

Prognostic Factors

As long as safeguards are taken, the prognosis is favorable. A risk factor for tinea infestations is hyperhidrosis. The sufferer should be instructed to completely dry their toes after taking a bath because the disease frequently begins on the feet.

When reinfection is to be prevented, the pieces must be completely dry. After washing, it is highly recommended that vulnerable individuals apply a quality antiseptic powder to their feet, paying special attention to the area in between their toes, to keep it dry.

An effective dusting mixture for the foot is clotrimazole or tolnaftate powder. To maintain the feet dry, simply sprinkle talcum powder onto the shoes and socks. When wearing heated occlusive boots, periodic administration of topical antifungal treatment may be necessary.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

terbinafine 

(Off-Label)
250 mg per day orally as a single dose or divided every 12 hours for 2-6 weeks



butenafine 

Cream- Apply the product onto the affected areas twice daily for at least a week; do not exceed more than 4 weeks
Gel- Apply onto the affected area twice daily for 7 days
Solution- Apply onto the affected area twice daily for 7 days



ciclopirox 

Apply the product onto clean & dry skin twice daily
Gently massage over the areas affected
If no improvement is seen after weeks, re-diagnose



tea tree oil 

Applying a 10% cream topically twice a day for one month or applying a 25-50% solution twice a day for one month is recommended



luliconazole 

Apply the cream to the affected area and approximately one inch of the adjacent area(s) once a day for two weeks



terbinafine topical 

Apply twice daily to the affected area until there is a substantial clinical improvement, but not exceeding a duration of 4 weeks



naftifine 


Indicated for Dermatophytoses
1% topical gel or cream: two times a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about four weeks
2% topical gel or cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Note:
2% topical gel or cream: It is generally indicated for therapy of interdigital tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum
1% topical gel: It is generally indicated for the therapy of tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum, Trichophyton Tonsurans, Epidermophyton floccosum, and Trichophyton mentagrophytes
1% topical cream: It is generally indicated for the therapy of tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum, Epidermophyton floccosum, and Trichophyton mentagrophytes



sertaconazole 

Apply twice daily for four weeks, covering the affected region completely and immediately surrounding good skin.
If there is no improvement two weeks following therapy, the diagnosis should be reconsidered.



betamethasone/clotrimazole 

Cream: Apply to infected area every 12hr for 1 week; after 1 week if there is no improvement; do not exceed more than 45 mL per week; for maximum of 4 weeks
Lotion: Apply to infected area every 12hr for 1 week; after 1 week if there no improvement; do not exceed more than 45 mL per week; for maximum of 4 weeks



 

butenafine 

For <12 years old, Safety & efficacy are not seen
For >12 years old, Same as in adults



ciclopirox 

For >12 years, refer to adult indications



luliconazole 

Age 2-18 years: Apply the cream to the affected area and the surrounding area(s) measuring approximately 1 inch in diameter once a day for 14 days



naftifine 


Indicated for Tinea Pedis
Age 12-17 years
2% topical gel or cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <12 years
Safety and efficacy not established
2% topical gel or cream: It is generally indicated for therapy of interdigital tinea pedis by Trichophyton rubrum
Tinea Cruris
Age 12-17 years
2% topical cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <12 years
Safety and efficacy not established
It is generally indicated for the therapy of tinea cruris by Trichophyton rubrum
Tinea Corporis
Age >2 years
1% topical cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <2 years
Safety and efficacy not established
It is generally indicated for the therapy of tinea corporis by Trichophyton rubrum



 

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References

https://www.ncbi.nlm.nih.gov/books/NBK470421/

Tinea Pedis

Updated : March 11, 2024




A dermatophyte fungus infection of the feet known as tinea pedis or foot worm affects the soles and interdigitates clefts of the nails, and toes. Athlete’s foot is another name for it.

Trichophyton rubrum, a dermatophyte that was historically endemic to various regions of Africa, Asia, and Australia, is the culprit behind the infection. Today, though, the organism is still present throughout the Americas and Europe.

Dermatophyte infections of the leg clefts may afflict ten percent of the general population. It is primarily blamed on wearing occlusive footwear for extended periods of time.

As the occurrence of tinea pedis is seen to be greater in patients using community baths, pools, and showers using sanitation facilities is likely to raise the odds of infection. Adult males are more likely than females to have the disease. One study found that the average age of onset was fifteen years.

Tinea pedis infection is likely caused by the blockage of foot clefts, maceration, and damp environments together with a growth in the microflora. This illness is influenced by skin deterioration, temperature, and humidity.

The fungus invaded the skin’s keratin layer by releasing keratinase enzymes. Additionally, mannans, which block the body’s immunological response, are found in the cell walls of dermatophytes.

Etiology

Trichophyton rubrum primarily causes tinea pedis. Additionally engaged are Epidermophyton floccosum and Trichophyton interdigitale. Tricholosporum violaceum is another sporadic agent. About 70% of the cases are caused by T. rubrum.

Risk elements consist of

  • a warm, muggy climate
  • Wearing occlusive shoes for a long time
  • Overly sweaty
  • Prolonged contact with water

As long as safeguards are taken, the prognosis is favorable. A risk factor for tinea infestations is hyperhidrosis. The sufferer should be instructed to completely dry their toes after taking a bath because the disease frequently begins on the feet.

When reinfection is to be prevented, the pieces must be completely dry. After washing, it is highly recommended that vulnerable individuals apply a quality antiseptic powder to their feet, paying special attention to the area in between their toes, to keep it dry.

An effective dusting mixture for the foot is clotrimazole or tolnaftate powder. To maintain the feet dry, simply sprinkle talcum powder onto the shoes and socks. When wearing heated occlusive boots, periodic administration of topical antifungal treatment may be necessary.

terbinafine 

(Off-Label)
250 mg per day orally as a single dose or divided every 12 hours for 2-6 weeks



butenafine 

Cream- Apply the product onto the affected areas twice daily for at least a week; do not exceed more than 4 weeks
Gel- Apply onto the affected area twice daily for 7 days
Solution- Apply onto the affected area twice daily for 7 days



ciclopirox 

Apply the product onto clean & dry skin twice daily
Gently massage over the areas affected
If no improvement is seen after weeks, re-diagnose



tea tree oil 

Applying a 10% cream topically twice a day for one month or applying a 25-50% solution twice a day for one month is recommended



luliconazole 

Apply the cream to the affected area and approximately one inch of the adjacent area(s) once a day for two weeks



terbinafine topical 

Apply twice daily to the affected area until there is a substantial clinical improvement, but not exceeding a duration of 4 weeks



naftifine 


Indicated for Dermatophytoses
1% topical gel or cream: two times a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about four weeks
2% topical gel or cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Note:
2% topical gel or cream: It is generally indicated for therapy of interdigital tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum
1% topical gel: It is generally indicated for the therapy of tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum, Trichophyton Tonsurans, Epidermophyton floccosum, and Trichophyton mentagrophytes
1% topical cream: It is generally indicated for the therapy of tinea pedis, tinea corporis, and tinea cruris by Trichophyton rubrum, Epidermophyton floccosum, and Trichophyton mentagrophytes



sertaconazole 

Apply twice daily for four weeks, covering the affected region completely and immediately surrounding good skin.
If there is no improvement two weeks following therapy, the diagnosis should be reconsidered.



betamethasone/clotrimazole 

Cream: Apply to infected area every 12hr for 1 week; after 1 week if there is no improvement; do not exceed more than 45 mL per week; for maximum of 4 weeks
Lotion: Apply to infected area every 12hr for 1 week; after 1 week if there no improvement; do not exceed more than 45 mL per week; for maximum of 4 weeks



butenafine 

For <12 years old, Safety & efficacy are not seen
For >12 years old, Same as in adults



ciclopirox 

For >12 years, refer to adult indications



luliconazole 

Age 2-18 years: Apply the cream to the affected area and the surrounding area(s) measuring approximately 1 inch in diameter once a day for 14 days



naftifine 


Indicated for Tinea Pedis
Age 12-17 years
2% topical gel or cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <12 years
Safety and efficacy not established
2% topical gel or cream: It is generally indicated for therapy of interdigital tinea pedis by Trichophyton rubrum
Tinea Cruris
Age 12-17 years
2% topical cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <12 years
Safety and efficacy not established
It is generally indicated for the therapy of tinea cruris by Trichophyton rubrum
Tinea Corporis
Age >2 years
1% topical cream: one time a day, topically apply near the affected area with an extra 0.5-inch of healthy skin for about two weeks
Age <2 years
Safety and efficacy not established
It is generally indicated for the therapy of tinea corporis by Trichophyton rubrum



https://www.ncbi.nlm.nih.gov/books/NBK470421/