How To Identify And Treat Pruritic Conditions In Athletes

Author(s): 
By Mark Caselli, DPM

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.    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.

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