Tinea pedis

Athlete's foot, tinea pedum.

Fungal disease of the feet.

• Classification
  • Dyshidrotic type
  • Hyperkeratotic-rhagadiform type
  • Interdigital type
  • Moccasin type
  • Oligosymptomatic type

Incidence: 20% - 80%

• Pathogen
  • Trichophyton rubrum (approx. 80%)
  • Trichophyton mentagrophytes (approx. 10%)
  • Epidermophyton floccosum (approx. 4%)
  • Microsporum canis
  • Microsporum gypseum
• Predisposing factors
  • Foot deformities
  • Frequent wearing of tight shoes
  • Trauma
  • Hyperhidrosis
  • Disorders of blood circulation (acrocyanosis)
  • Diabetes mellitus
  • Peripheral neuropathy
  • Familial disposition
  • Male gender

• Infection by dermatophytes (see above). Transmission can occur from person to person or via the floor (indoor swimming pool)

• Dyshidrotic foot eczema: Palmar dyhidrotic vesicles localised especially in the arch of the foot
• Interdigital type: rhagades and dry scales appear interdigitally
• Moccasin type: Whitish, scaly plaques. Distribution resembles moccasins
• Hyperkeratotic-rhagadiform type: Pronounced hyperkeratoses are in the foreground. There is often painfulness when walking if rhagades are present.
• Oligosymptomatic type: Interdigital minimal redness and fine scaling. Hyperkeratosis may be seen on the edges of the feet

• Clinic
• Detection of pathogens (scales, pustule contents: native and culture; biopsy)

• Erysipelas
• Contact allergy
• Tinea unguium

• Clotrimazole spray 2-3x / week
• CAVE: Prolonged topical antifungal treatment may result in gram-negative forefoot infection (expulsion of gram-positive flora)

Chronic progression.

• Topical therapy
• Clotrimazole cream
• Terbinafine (cream 1%, solution 1%, spray)
• Ketoconazole cream (cream 2%)
• Amorolfin cream (0.25% cream)
• Griseofulvin cream: not on the market in Switzerland
• Bifonazole cream: not on the market in Switzerland
• Econazole (cream 1%)
• Ciclopirox (cream or solution)

• The spaces between the toes should always be kept dry
• Walking on bare feet should be avoided
• As fungi can also be found in socks and shoes, we recommend: Wash all! Socks with at least 60°C
• Consistent disinfection of the footwear (e.g.: with commercially available disinfectant spray such as: Octenidin)

1. Aste N, Pau M, Aste N, Biggio P. Tinea pedis observed in Cagliari, Italy, between 1996 and 2000. Tinea pedis in Cagliari, Italien, zwischen 1996 und 2000. Mycoses 2003;46:38-41.
2. Lachapelle JM, De Doncker P, Tennstedt D, Cauwenbergh G, Janssen PA. Itraconazole compared with griseofulvin in the treatment of tinea corporis/cruris and tinea pedis/manus: an interpretation of the clinical results of all completed double-blind studies with respect to the pharmacokinetic profile. Dermatology 1992;184:45-50.
3. Lacroix C, Baspeyras M, de La Salmoniere P, et al. Tinea pedis in European marathon runners. Journal of the European Academy of Dermatology and Venereology 2002;16:139-42.
4. Lupa S, Seneczko F, Jeske J, Glowacka A, Ochecka-Szymanska A. Epidemiology of dermatomycoses of humans in Central Poland. Part III. Tinea pedis. Mycoses 1999;42:563-5.
5. Satchell AC, Saurajen A, Bell C, Barnetson RS. Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: A randomized, placebo-controlled, blinded study. Australas J Dermatol 2002;43:175-8.
6. Goldstein, A. (2016). Dermatophyte (tinea) infections. Uptodate.com. Retrieved 30 May 2016, from http://www.uptodate.com/contents/dermatophyte-tinea-infections?source=search_result&search=tinea+corporis&selectedTitle=1~51