Fungus

Tinea Pedis

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Tinea Pedis, Tinea Manum, Tinea Manuum, Tinea Manus, Athlete's Foot

  • See Also
  1. Hand Dermatitis
  2. Foot Dermatitis
  3. Intertrigo
  4. Skin Infection
  5. Cutaneous Fungal Infection
  • Definitions
  1. Tinea Manus (or Tinea Manuum)
    1. Dermatophyte Infection of hand
  2. Tinea Pedis
    1. Dermatophyte Infection of foot
  • Risk Factors
  1. Heat
  2. Dampness
  3. Occlusive shoes
  • Symptoms (most commonly affects foot)
  1. Pruritus
  2. Burning
  • Signs
  1. General
    1. Interdigital erythema maceration at web space
    2. Dry ScalingPlaques
    3. Fissuring
    4. Vesicles may be present
  2. Subtypes
    1. Vesiculobullous lesions
      1. Involves sole of foot
      2. Associated with Cellulitis and lymphangitis
    2. Moccasin (Sandal)
      1. Diffuse involvement of sole and lateral foot
      2. Often presents as hyperkeratosis with Scaling of the sole
      3. Associated with Trichophyton rubrum infection
      4. May require systemic Antifungal for eradication
    3. Two foot and one hand disease
      1. Scaling of 1 hand and 2 feet
  • Labs
  1. Potassium Hydroxide (KOH)
  2. Culture
    1. Staphylococcus aerobic coryneforms
    2. Gram Negative Bacteria
    3. Resistant fungal organisms suspected
  • Differential Diagnosis
  1. See Hand Dermatitis or Foot Dermatitis
  2. Dyshidrotic Eczema
  3. Contact Dermatitis
  4. Atopic Dermatitis
  5. Reiter's Syndrome
  6. Psoriasis
  7. Pustular Psoriasis
  8. Candidiasis
  9. Intertrigo
  10. Erythrasma
  11. Local callus formation
  12. Local Bacterial Infection (Cellulitis)
    1. Staphylococcus aerobic coryneforms
    2. Gram Negative toe web-space infections (often secondary to Fungal Infection) are similar with exceptions
      1. More painful
      2. More likely to extend to the plantar surface
    3. Pseudomonas Aeruginosa
      1. Most common of the Gram Negative toe space infections
      2. Associated with foul smelling, green discharge
  13. Juvenile plantar dermatosis
    1. Shiny taut skin of the great toe, ball of the foot and heel
    2. Spares the web spaces
  • Management
  1. Emphasize Foot care
    1. Avoid occlusive footwear
    2. Change to dry socks 2-3 times daily
    3. Dry between toes twice daily
    4. Change or alternate shoes
  2. Control Hyperhidrosis
    1. Highly absorbent powder (e.g. Zeasorb)
    2. Drysol (20% aluminum hydroxide) applied bid
    3. Lazer Formalyde Solution (10% formaldehyde) applied
    4. Place lamb's wool piece between toes
  3. Lac-Hydrin cream (for Tinea Manum)
  4. Topical Antifungal (twice daily for 3-4 weeks)
    1. Technique
      1. Apply to normal skin 2 cm beyond affected area
      2. Continue for 7 days after symptom resolution
    2. First line: Imidazoles (e.g. Clotrimazole, OTC)
    3. Second line: Ciclopirox (Loprox) lotion or cream
    4. Refractory cases
      1. Terbinafine (Lamisil)
      2. Butenafine (Mentax)
      3. Naftifine (Naftin)
  5. Systemic Antifungals
    1. Indicated in severe or refractory cases (not usually needed)
    2. Agents (dosing listed for adults)
      1. Terbinafine 250 mg orally once daily for 14 days or
      2. Fluconazole 150 mg orally once weekly for 3 weeks
  6. Treat Bacterial superinfection with Antibiotics
    1. See Complications below
  7. Non-effective methods
    1. Avoid daily prophylaxis (not cost effective)
    2. Avoid Tea tree oil (equivalent to Placebo for cure)
  • Complications
  1. ID Reaction
  2. Secondary Bacterial Cellulitis
    1. See Tinea Pedis Superinfection
  • Prevention
  1. Avoid walking barefoot in bathrooms and locker rooms
  2. Keep skin clean and dry
  • References
  1. Andrews (2008) Am Fam Physician 77(10): 1415-20 [PubMed]
  2. Caplan (2025) Am Fam Physician 112(4): 382-92 [PubMed]
  3. Schwartz (2004) Lancet 364(9440):1173-82 [PubMed]
  4. Evans (1993) BMJ 307:645-7 [PubMed]
  5. Tong (1992) Australas J Dermatol 33:145-9 [PubMed]