Tinea pedis (overview) B35.30

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Athlete`s foot; Athlete's Foot; Athlete's Foot Disease; Epidermophytia pedis; Foot fungus; Mycosis pedis; ringworm; Ringworm of the foot

Definition
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Fungal disease ( tinea) of the feet. Most common fungal disease with an incidence of 20% up to 80% (miners, soldiers) depending on the collective.

Pathogen
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Classification
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  • Dyshidrotic type (vesicular form): Itchy, cloudy blisters that heal with scaly crust formation, especially in the arch of the foot.
  • Interdigital type (dry or macerative form): Dry scaly or macerated, grey-white, swollen skin, erosions, rhagades in the interdigital spaces.
  • Moccasin type: Usually dry scaling, white or slightly reddened, usually not bordered plaques on the sole of the foot in the form of a moccasin ( moccasin mycosis).
  • Squamous-hyperkeratotic type (hyperkeratotic-rhagadiform tinea): Mainly foot edges, tiptoes, heel are affected. Well defined, focal, scaly hyperkeratoses, possibly with rhagades.
  • Oligosymptomatic type: Minimal reddening of the interdigital space. Hyperkeratosis with fine-lamellar scaling on heels and foot edges. Often also tinea unguium.

Occurrence/Epidemiology
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  • In Germany an estimated 10 million people suffer from tinea pedis.
  • In larger Japanese dermatological patient groups (n=36,000), tinea pedis was represented with 8.2% (Sei Y 2015)
  • Weighting of the risk factors in descending order:
    • Family disposition
    • Foot malpositions
    • Use of public bathing facilities or use of public changing rooms
    • occlusive effect by wearing tight shoes (sports shoes)
    • Male gender
    • Traumas
    • Peripheral neuropathy
    • diabetes mellitus
    • Circulatory problems.

Etiopathogenesis
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Ubiquitous fungi (T. rubrum, T. mentagrophytes). Indirect infection from person to person by walking barefoot in swimming pools, gymnasiums etc. Favouring factors: airtight shoes, hyperhidrosis, acrocyanosis, arterial and venous circulatory disorders.

Clinical features
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  • Dyshidrotic type (vesicular form): Itchy, cloudy blisters that heal with scaly crust formation, especially in the arch of the foot.
  • Interdigital type (dry or macerative form): Dry scaly or macerated, grey-white, swollen skin, erosions, rhagades in the interdigital spaces.
  • Moccasin type: usually dry scaling, white or slightly reddened, usually not bordered plaques on the sole of the foot in the form of a moccasin ( moccasin mycosis).
  • Squamous-hyperkeratotic type (hyperkeratotic-rhagadiform tinea): Mainly foot edges, tiptoes, heel are affected. Well defined, focal, scaly hyperkeratoses, possibly with rhagades.
  • Oligosymptomatic type: Minimal reddening of the interdigital space. Hyperkeratosis with fine-lamellar scaling on heels and foot edges. Often also tinea unguium.

Diagnosis
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Native and cultural fungus detection (procedure: see under Mycology examination methods).

Differential diagnosis
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Complication(s)
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Erysipelas, therapy-related contact allergy, tinea unguium.

Therapy
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Antimycotics external, see below Tinea. Dry blow-drying of the interdigital space. Removal of terrain factors (wearing of bathing shoes in swimming pools and sauna and wellness areas), disinfection of stockings and shoes (e.g. Cutasept Spray), daily change of stockings. Washing of stockings and towels at 60 °C or with addition of disinfectants (Sagrotan laundry solution, Impressan laundry solution). Let shoes dry for at least one day. Cleaning of carpets, floor coverings (especially in the bathrooms), etc.

Progression/forecast
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Mostly highly chronic course. Tinea pedis can be the starting point for mycoses of other localisations, e.g. nail mycoses of the toes and fingers, the groins or other body regions. No self-healing tendency!

Prophylaxis
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  • Wearing of bathing shoes in public communal facilities such as changing rooms, showers and sauna. Use of disinfectant foot sprays in swimming pools.
  • Prophylactic use of antimycotic solutions/sprays (e.g. Canesten spray) 2-3 times/week in interdigital spaces and on the soles of the feet.
  • Disinfection of contaminated objects (e.g. disinfection of shoes with Sagrotan spray).
  • Clean rubbing of the feet with a towel or washing of the feet with soap can reduce the number of fungi on the soles of the feet. Avoid walking barefoot on the carpet of hotel rooms.

Naturopathy
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  • Lavender oil can be used as an alternative to disinfectants: 10 drops/l. The disinfectant effect is 22 times stronger than that of the above disinfectants.
  • In naturopathy, vinegar applications are also mentioned. Dab affected areas with undiluted apple vinegar several times a day and before going to bed. Daily apple vinegar baths are also recommended.
  • A naturopathic alternative is 25% or 50% tea tree preparations or 1% eucalyptus oil. Both preparations are probably based on the antimicrobial effect of cineol.

Diet/life habits
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T. pedum is practically not observed in barefoot primitive people.

Aftercare
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Wearing of bathing shoes in public communal facilities such as changing rooms, showers and sauna. Use of disinfectant foot sprays in swimming pools. Prophylactic use of antimycotic solutions/sprays (e.g. Canesten spray) 2-3 times/week in interdigital spaces and on the soles of the feet. Disinfection of contaminated objects (e.g. disinfection of shoes with Sagrotan spray). Clean rubbing of the feet with a towel or washing of the feet with soap can reduce the number of fungi on the soles of the feet. Avoid walking barefoot on the carpet of hotel rooms.

Note(s)
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In a randomized double-blind study it could be shown that a therapy with Terbinafine cream 1% over 7 days (once/day) is sufficient to cure a Tinea pedum interdigitalis.

Literature
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  1. Satchell AC et al (2002) Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomizeid, placebo controlled blinded study. Australas J Dermatol 43: 175-178
  2. Seebacher C et al (2007) Onychomycosis. J Dtsch Dermatol Ges 5: 61-66
  3. Seebacher C et al (2005) Tinea of the free skin. J Dtsch Dermatol Ges 11: 921-926
  4. Sei Y (2015) 2011 Epidemiological Survey of Dermatomycoses in Japan. Med Mycol J 56:J129-135
  5. Shahi SK et al (2000) Broad spectrum herbal therapy against superficial superficial fungal infections. Skin Pharmacol Appl Skin Physiol 13: 60-64

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020