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Published On: Sun, Dec 21st, 2014

Athlete’s Foot

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Athlete’s Foot

Athlete’s Foot

Health Matters by Dr. Longwap AbdulAziz Saleh

e-mail: longwapabdul@yahoo.com | Text: 08039537913

How you treat athlete’s foot (tineapedis) depends on its type and severity. Most cases of athlete’s foot can be treated at home using an antifungal medicine to kill the fungus or slow its growth. The disease is a common and contagious dermatophyticfungal infection of the skin that causes scaling, flaking, and itching of the affected areas. The disease is typically transmitted in moist communal areas where people walk barefoot, such as showers or bathhouses, and requires a warm moist environment such as the inside of a shoe to incubate.

Globally, fungal infections affect about 15% of the population and affects one out of five adults. Athlete’s foot is most common among adolescentsand in individuals who wear occlusive shoes. Studies have demonstrated that men are infected 2–4 times more often than women.

The condition typically affects the feet, but may infect or spread to other areas of the body such as the groin and tends to spread to areas of skin that are kept hot and moist, such as with insulation, body heat, and sweat.

Causes

The fungal agents responsible for infection may be picked up by walking barefoot in an infected area or using an infected towel. Infection can be prevented by limiting the use of occlusive footwear and remaining barefoot. Athlete’s foot is most commonly caused by the fungi Trichophytonrubrum or T. mentagrophytesbut may also be caused by Epidermophytonfloccosum. Most cases of athlete’s foot in the general population are caused by T. rubrum; however, the majority of athlete’s foot cases in athletes are caused by T. mentagrophytes.

SIGNS AND SYMPTOMS

Athlete’s foot may be divided into three different presentations: interdigital, plantar (moccasin foot), and vesiculobullous.

Cases of interdigital athlete’s foot (between the toes) caused by Trichophytonrubrum may be asymptomatic or have pruritic erythema, scaling, flaking, and maceration (softening and whitening of skin that has been kept wet) of the interdigital spaces between the toes. A complex variant of interdigital athlete’s foot caused by T. mentagrophytes is characterized by pain, maceration of the skin, erosions and fissuring of the skin, crusting, and an odor due to bacterial infection of the skin.

Plantar athlete’s foot (moccasin foot) is asymptomatic, slightly erythematous plaques to form on the plantar surface (sole) of the foot that are often covered by hyperkeratotic scales. The vesiculobullous type of athlete’s foot is usually caused by T. mentagrophytes and is characterized by a sudden outbreak of itchy blisters and vesicles on an erythematous base, usually appearing on the sole of the foot.

DIAGNOSIS

Athlete’s foot can usually be diagnosed by visual inspection of the skin, but if the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete’s foot and help rule out other possible causes, such as candidiasis, pitted keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis. Dermatophytes known to cause athlete’s foot will demonstrate multiple septate branching hyphae on microscopy.

A Wood’s lamp (black light), although useful in diagnosing fungal infections of the scalp (tineacapitis), is not usually helpful in diagnosing athlete’s foot, since the common dermatophytes that cause this disease do not fluoresce under ultraviolet light.[11]

TRANSMISSION

The fungi that cause athlete’s foot require warmth and moisture to survive and grow. There is an increased risk of infection with exposure to warm, moist environments (e.g., occlusive footwear) and in shared humid environments such as communal showers, shared pools, and treatment tubs.[10]

Due to their insulating nature and the greatly reduced ventilation of the skin, shoes are the primary cause of the spread of athlete’s foot.[6] As such, the fungus is only seen in approximately 0.75% of habitually barefoot people.[16] Always being barefoot allows full ventilation around the feet that allows them to remain dry and exposes them to sunlight, as well as developing much stronger skin and causes the fungus to be worn off and removed before it can infect the skin. This even further minimizes the chances of infection as it ventilates the warm moist pockets of skin between the third, fourth and fifth toes in shoe-wearing people.

Athlete’s foot can also be transmitted by sharing footwear with an infected person, such as at a bowling alley or any other place that lends footwear. A less common method of infection is through sharing towels. The various parasitic fungi that cause athlete’s foot can also cause skin infections on other areas of the body, most often under toenails (onychomycosis) or on the groin (tineacruris).

Prevention

There are several lifestyle modifications that can be practiced to prevent athlete’s foot. Effective preventive measures include keeping the feet dry, using socks made of synthetic materials designed to remove moisture, wearing well ventilated footwear, changing socks frequently, and wearing sandals while walking through communal areas such as gym showers and locker rooms. Recurrence of athlete’s foot can be prevented with the use of antifungal powder on the feet.

Athlete’s foot treatment

How you treat athlete’s foot (tineapedis) depends on its type and severity. Most cases of athlete’s foot can be treated at home using an antifungal medicine to kill the fungus or slow its growth.

  • Nonprescription antifungals usually are used first. These include clotrimazole, miconazole, terbinafine, and tolnaftate. Nonprescription antifungals are applied to the skin (topical medicines).
  • Prescription antifungals may be tried if nonprescription medicines are not successful or if you have a severe infection. Some of these medicines are topical antifungals, which are put directly on the skin. Examples include butenafine, clotrimazole, and naftifine. Prescription antifungals can also be taken as a pill, which are called oral antifungals. Examples of oral antifungals include fluconazole (Diflucan), itraconazole (Sporanox), and terbinafine (Lamisil).

For severe athlete’s foot that doesn’t improve, your doctor may prescribe oral antifungal medicine (pills). Oral antifungal pills are used only for severe cases, because they are expensive and require periodic testing for dangerous side effects. Athlete’s foot can return even after antifungal pill treatment.

Even if your symptoms improve or stop shortly after you begin using antifungal medicine, it is important that you complete the full course of medicine. This increases the chance that athlete’s foot will not return. Reinfection is common, and athlete’s foot needs to be fully treated each time symptoms develop.

Toe web infections

Toe web infections occur between the toes, especially between the fourth and fifth toes. This is the most common type of athlete’s foot infection.

  • Treat mild to moderate toe web infections by keeping your feet clean and dry and using nonprescription antifungal creams or lotions.
  • If a severe infection develops, your doctor may prescribe a combination of topical antifungal creams plus either oral or topical antibiotic medicines.

Moccasin-type infections

Moccasin-type athlete’s foot causes scaly, thickened skin on the sole and heel of the foot. Often the toenails become infected (onychomycosis). A moccasin-type infection is difficult to treat, because the skin on the sole of the foot is very thick.

  • Nonprescription medicines may not penetrate the thick skin of the sole well enough to cure moccasin-type athlete’s foot. In this case, a prescription topical antifungal medicine that penetrates the sole, such as ketoconazole, may be used.
  • Prescription oral antifungal medicines are sometimes needed to cure moccasin-type athlete’s foot.

Conclusion

If you notice any redness, increased swelling, bleeding, or if your infection is not clearing up, see your health-care professional. If a bacterial infection is also occurring, an antibiotic pill may be necessary. If you have fungal nail involvement, are diabetic, or have a compromised immune system, you should also see your physician for treatment.

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