Dermatology Book

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Tinea PedisAka: Tinea Manum, Athlete's Foot

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  1. See Also
    1. Intertrigo
  2. Definitions
    1. Tinea manum: Dermatophyte infection of hand
    2. Tinea pedis: Dermatophyte infection of foot
  3. Predisposing factors
    1. Heat
    2. Dampness
    3. Occlusive shoes
  4. Symptoms (most commonly affects foot)
    1. Pruritus
    2. Burning
  5. Signs
    1. General
      1. Interdigital maceration at web space
      2. Dry Scaling Plaques
      3. Fissuring
    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 dorsum
        2. Often presents as Scaling of 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
  6. Labs
    1. Potassium Hydroxide (KOH)
    2. Culture
      1. Staphylococcus aerobic coryneforms
      2. Gram Negative Bacteria
  7. 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. Candidiasis
    8. Intertrigo
    9. Erythrasma
    10. Local Bacterial infection (Cellulitis)
    11. Local callus formation
  8. 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. Drysol (20% aluminum hydroxide) applied bid
      2. Lazer Formalyde Solution (10% formaldehyde) applied
      3. Place lamb's wool piece between toes
    3. Lac-Hydrin cream (for tinea manum)
    4. Topical Antifungal (bid 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: Allylamines (e.g. Naftin, Lamisil)
    5. Treat bacterial superinfection with antibiotics
      1. See Complications below
    6. Non-effective methods
      1. Avoid daily prophylaxis (not cost effective)
      2. Avoid Tea tree oil (equivalent to Placebo for cure)
  9. Complications
    1. ID Reaction
    2. Secondary bacterial Cellulitis
      1. See Tinea Pedis Superinfection
  10. References
    1. Evans (1993) BMJ 307:645
    2. Tong (1992) Australas J Dermatol 33:145

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