Tinea pedis

Background

  • The most common dermatophyte infection
  • Most commonly in young men
  • Caused by T. rubrum, T. interdigitale, and E. floccosum
  • Spread through direct contact (locker rooms, near swimming pools)
  • Manifests as interdigital, hyperkeratotic, or vesiculobulbous eruption, rarely ulcerative
  • Often accompanied by other forms of tinea

Tinea Types

Clinical Features

Interdigital tinea pedis
Hyperkeratotic tinea pedis
  • Interdigital tinea pedis: pruritic, erythematous erosions between the toes, can be associated with painful fissures (most common type)
  • Hyperkeratotic tinea pedis (mocasin-type): A mocasin distribusion of hyperkeratosis on the soles and side of the feet
  • Vesiculobullous tinea pedis (inflammatory): Pruritic or painful vessicles or bullae with underlying erythema often affecting the medial foot
  • Ulcerative tinea pedis: Interdigital erosions or ulcers (uncommon and usually associated with secondary bacterial infection)

Differential Diagnosis

  • Interdigital tinea pedis
    • Erythrasma
    • Interdigital Candida infection
  • Hyperkeratotic tinea pedis
    • Atopic dermatitis
    • Chronic contact dermatitis
    • Acute palmoplantar eczema
    • Palmoplantar psoriasis
    • Pitted keratolysis
    • Juvenile plantar dermatosis
    • Keratolysis exfoliativa
    • Keratodermas
  • Vesiculobullous tinea pedis
    • Acute palmoplantar eczema
    • Acute contact dermatitis
    • Palmoplantar pustulosis

Foot diagnoses

Acute

Subacute/Chronic

Evaluation

  • Generally a clinical diagnosis
  • Diagnosis can by confirmed by detecting segmented in hyphae in skin scrapings when put in KOH prep

Management

  • Topical antifungals: Clotrimazole, terbinafine
  • treatment to reduce symptoms, prevent secondary bacterial infection, and limit spread
  • Systemic antifungals reserved for patients who fail topical therapy
  • Systemic antifungals that can be used include: terbinafine, itraconazole, and fluconazole

Disposition

  • Outpatient treatment

See Also

References

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