Updated: 12/16/2021

Tinea Pedis / Manuum

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https://upload.medbullets.com/topic/121594/images/atheletesfoot.jpg
https://upload.medbullets.com/topic/121594/images/tineamanuum.jpg
https://upload.medbullets.com/topic/121594/images/koh prep fungus.jpg
https://upload.medbullets.com/topic/121594/images/athletes-foot sole.jpg
https://upload.medbullets.com/topic/121594/images/athletes_foot_pict_plantar_2(1).jpg
  • Snapshot
    • A 40-year-old woman presentsto 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‚Äôs foot
        • tinea manuum
          • superficial fungal skin infection of the hand
    • Associated conditions
      • tinea cruris
      • onychomycosis
  • 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
    • Pathogenesis
      • fungus infects superficial keratinized tissue
        • limited to stratum corneum, hair, or nails
      • dermatophytes require keratin to grow
    • Dermatophytes
      • Trichophyton
        • most commonly Trichophyton rubrum and Trichophyton interdigitale
      • Microsporum
      • Epidermophyton
  • 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
  • Prognosis
    • responsive to topical treatment
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