How To Detect And Treat Tinea Pedis

By Barry Blass, DPM

   Fungal infections of the foot represent the fourth most common problem that we see in podiatric practice.1 Approximately 26.5 million people are affected annually.2 Nearly half of these people will suffer from multiple episodes for years. Treatment varies from home remedies and OTC preparations to a large variety of topical and oral medications. While tinea pedis is certainly is not the most challenging condition we treat, eliminating a longstanding, annoying and embarrassing condition can make the practitioner a hero in the eyes of his or her patient.    I will leave the in-depth discussion of the categories of tinea infections of the foot to the dermatology textbooks. However, as a brief reminder, there are four basic presentations.    Chronic squamous or papulosquamous tinea presents with dry, thick scales, frequently with fissuring on the plantar surface. The classical presentation is in a moccasin-type distribution. Interdigital tinea presents with maceration, scaling and itching between the toes. It frequently spreads to the plantar surface proximal to the web spaces. Acute vesicular or vesiculobullous tinea usually appears in non-weightbearing areas such as the longitudinal arch. It usually displays small vesicles and bulla on erythematous bases. Acute ulcerative tinea classically involves larger areas with desquamation of layers of tissue, foul odor and drainage.    Although all tineas can lead to secondary infection, the acute ulcerative tinea is the most likely presentation to do so. This is a matter of increased concern for patients with diabetes, those with vascular disease and immunocompromised individuals.

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