Fast Five Quiz: Hygiene-Related Diseases

Richard H. Sinert, DO

Disclosures

May 04, 2021

Patients with tinea pedis commonly describe pruritic, scaly soles and painful fissures between the toes. Less often, patients describe vesicular or ulcerative lesions. Some patients with tinea pedis, especially elderly persons, may simply attribute their scaling feet to dry skin.

The ulcerative variety is characterized by rapidly spreading vesiculopustular lesions, ulcers, and erosions, typically in the web spaces, and is often accompanied by a secondary bacterial infection. Cellulitis, lymphangitis, pyrexia, and malaise can accompany this infection. Occasionally, large areas, even the entire sole, can be sloughed. This type is commonly seen in immunocompromised and diabetic patients.

The hyperkeratotic type of tinea pedis is characterized by chronic plantar erythema with slight scaling to diffuse hyperkeratosis. This type can be asymptomatic or pruritic. This type is also called "moccasin tinea pedis," after its moccasin-like distribution. Both feet are usually affected. Typically, the dorsal surface of the foot is clear; however, in severe cases, the condition may extend onto the sides of the foot.

The interdigital presentation is the most characteristic type of tinea pedis, with erythema, maceration, fissuring, and scaling, most often between the fourth and fifth toes. This type is often accompanied by pruritus. The dorsal surface of the foot is usually clear, but some extension onto the plantar surface of the foot may occur. This type can be associated with the dermatophytosis complex, which is an infection with fungi followed by an infection with bacteria.

Patients with tinea pedis should be educated that reinfection can occur if they are re-exposed to dermatophytes. Old shoes are often sources of reinfection and should be disposed of or treated with antifungal powders.

Patients should be cautioned to wear protective footwear at communal pools and baths and should attempt to keep their feet dry by limiting occlusive footwear. When occlusive footwear is worn, wearing cotton socks and adding a drying powder with antifungal action in the shoes may be helpful.

Read more about tinea pedis.

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