Updated: 2/1/2018

Tinea Pedis / Manuum

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Snapshot
  • A 40-year-old woman presentsPhototo her dermatologist for a rash on her foot. She reports that this has been going on for about 2 weeks now ever since she started walking around her home barefoot. Her foot is pruritic and has caused her to continuously scratch the affected area. Physical exam reveals erythema, scales, and macerations on her left foot. There are similar findings on her right hand. She is prescribed an antifungal cream for treatment of both her hand and foot rash.
 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 and/or burning
        • especially between the toes or fingers
      • sloughing of skin on feet
  • Physical exam
    • erythema and overlying scale
    • 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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