How To Identify And Treat Pruritic Conditions In Athletes

By Mark Caselli, DPM

   Prevention of impetigo is paramount in athletes. Cleanliness and proper treatment of superficial skin injuries is paramount. Other methods of prevention and thwarting the spread of impetigo include good personal hygiene, and meticulous cleaning of wrestling mats and other equipment with antiseptic agents. Due to the infectious nature of impetigo, the lesions should be clear of crusting before athletic participation is allowed.

How To Handle Erythrasma

   Three similarly presenting pruritic skin infections of the foot include erythrasma, tinea pedis and candidiasis. They are caused by either a bacterial, fungal or yeast-like fungal organism, respectively.

   Erythrasma is a bacterial infection involving the toe web area. This condition is frequently confused with fungal and candidal infections. The invading organism is Corynebacterium minutissimum. Predisposing factors include humidity, hyperhydrosis, heat, obesity and poor foot hygiene. This condition usually involves the third and fourth toe web spaces. Painful longitudinal fissures may occur in advanced cases. Erythrasma differs from fungal infections in that it has no advancing borders, is uniformly reddish brown and scaly, and fluoresces bright coral-red with Wood’s light.

   Treatment involves extensive washing of the involved area with antibacterial soap and thorough drying after each wash. Topical 2% erythromycin solution is curative when patients apply it daily. In severe cases, it may be necessary to prescribe oral erythromycin 1 gram daily for seven days.

Understanding The Various Types Of Tinea Pedis

   Tinea pedis presents as a dry, often pruritic, erythematous scaling of the soles. In severe cases, macerated, erosive or bullous lesions develop in the web spaces. Bacterial superinfection is common. One may confuse blistering (vesicular) tinea with contact dermatitis or dyshydrotic eczema. Tinea pedis is caused by a number of different fungi, most commonly Trichophyton rubra, Epidermophyton floccosum and Trichophyton mentagrophytes. The single most important test for diagnosing tinea pedis is direct visualization under the microscope of branching hyphae in keratinized material on the KOH wet mount preparation slide.

   The three most common variants of tinea pedis one sees in athletes include the acute vesicular type, the chronic papulosquamous pattern and the chronic interdigital form.

   Acute vesicular tinea pedis usually begins in the arch and leads to pruritic inflammation, which may be severe. Vesicles and blisters are common and may spread from the arch to the sides of the foot. This variant may be inactive during the cooler months with severe exacerbation during warmer or wetter months. The most common fungus cultured is T. mentagrophytes. Occasionally, one may encounter Epidermophyton floccosum. Treatment with most topical antifungal creams is usually effective.

   Chronic papulosquamous tinea pedis is the most common variant of dermatophyte infection of the foot. A moccasin-type distribution on the foot consists of a dry, thick scale on the sole and sides of the foot. This infection is most commonly caused by T. rubrum. The hands may be similarly infected but it is very uncommon for both hands and both feet to show involvement. The common pattern is for both feet and one hand to be infected.

   Topical treatment of chronic tinea pedis alone may not be sufficient to treat the more tenacious infections. A combination of local skin care, topical antifungal agents and systemic antifungal agents may be necessary to eradicate the condition. A topical corticosteroid may also be indicated to resolve the accompanying acute pruritis. Unfortunately, reappearance of the infection is common after stopping the therapy program.

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