How To Identify And Treat Pruritic Conditions In Athletes

Author(s): 
By Mark Caselli, DPM

   Chronic interdigital tinea pedis usually starts in the toe web spaces and is characterized by scaling, maceration and itching. The infection commonly spreads from the interdigital web spaces to across the subdigital areas. T. mentagrophytes is commonly isolated from cultures from the interdigital web spaces. E. floccosum and T. rubrum may also be isolated. Treatment of the interdigital tinea pedis is very successful with topical antifungal solutions or creams that patients apply twice a day.

What About Candidiasis?

   Candidiasis, also known as candidosis and monilias, is another infection that one may see between the fourth and fifth toes. It is characterized by maceration, desquamation and deep fissuring with a white rim of tissue. This infection is caused by a yeast-like fungus Candida albicans.

   Factors that predispose a patient to candidiasis include: local occlusion resulting in heat, moisture and maceration; cutaneous trauma; a suppressed immune system; endocrinopathy such as diabetes mellitus; and preexisting ulcerations or fissures. Patients often complain of intense itching and burning.

   When it comes to relieving the maceration, using warm water and Epsom salt foot soaks helps when one ensures through drying afterward. Applying topical antifungal creams and solutions to the web spaces two or three times daily usually provides rapid clearing of the infection.

Why Parasitic Infestations May Be The Culprit

   One should consider parasitic infestations as possible causes when an athlete complains of severe itching. Two common infestations include cutaneous larva migrans and scabies. Cutaneous larva migrans (“creeping eruption”) is caused by hookworm larvae of various nematode parasites. The cat or dog hookworms, Ancylostoma braziliense and A. caninum, are the most common species in the southeastern United States, South America and many tropical countries. The adult nematodes are found in the intestines of dogs and cats. They deposit ova that are secreted in the feces. The ova hatch into larvae in the sand or soil where they are deposited. The larvae then penetrate human skin that comes into contact with them. This usually occurs as the athlete is sitting, standing or lying on the soil or sandy beach.

   The condition is extremely common on the hands, feet, legs and buttocks region. One should suspect this condition among athletes who are involved in swimming or beach volleyball. Most infected patients complain of moderate to intense pruritis. The larva stays deep in the epidermis, directly ahead of the advancing tip of a serpiginous tract.

   Treatment of cutaneous larva migrans begins with light freezing of the advancing border tip of the larva tract and the area of predicted travel of the larva with ethyl chloride spray. Using topical thiabendazole 10% aqueous solution is recommended for treating mild infections during the early stages of the infestation. Another option is oral thiabendazole (Mintezole), which is usually effective in resolving the pruritis in less than 12 hours. One may also employ topical corticosteroids to relieve severe urticaria if it is present.

   Human scabies is a contagious disease caused by the itch mite, Sarcoptes scabiei var. hominis. Keep in mind that this itch mite produces a variety of cutaneous lesions, such as macules, papules, vesicles, pustules, bullae, nodules and scaling plaques, which one may confuse with the lesions of many other skin diseases. The pregnant female mite burrows into the stratum cornium and deposits her eggs and fecal material. The lesions produced are usually elevated and represent the active portion of the infestation.

   The main symptom of scabies is intense pruritis. The itching is more pronounced in the evening or at night and after warm baths when mites appear to be more active. Scabies is usually contracted by close personal contact. The most prominent sites on the lower extremities are the interdigital spaces and soles of the feet.

   Topical medications used for treating scabies include lindane (1% gamma benzene hexachloride), crotamine (10% N-ethyl-o-crotonotoluide), sulfur ointment (5% precipitated sulfur), permethrin, thiabendazole and coal tar.

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