ATHLETE'S FOOT

'Athlete's foot' or 'tinea pedis'The term "tinea pedis" refers to the disease and not the organism (fungus) that causes it. Several different fungi, called dermatophytes, can cause tinea pedis. Moreover, a fungi species that causes athlete's foot can also cause, for example, ''jock itch'' (tinea cruris). is a parasitic fungal infection of the epidermis of the foot. It is typically caused by a mold A mold is a microscopic fungi that grows in a network of hyphae, as opposed to microscopic fungi that grow as singles cells, which are called yeasts. (but in some cases a yeast) that grows on the surface of the skin and then grows into the living skin tissue itself, causing the infection. It usually occurs between the toes, but in severely lasting cases may appear as an extensive "moccasin" pattern on the bottom and sides of the foot. The malady more commonly affects males than females [1] Risk factors for athlete's foot, at WebMD. Tinea
pedis is estimated to be the second most common skin disease in the United States, after acne Treatment of common superficial tinea infections, , Andrew, Weinstein, American Family Physician, American Family Physician journal website . Up to 15% of the U.S. population may have tinea pedis Oral treatments for fungal infections of the skin of the foot., , , Bell-Syer, Cochrane database of systematic reviews, .

Causes

The body normally hosts a variety of saprotrophic microorganisms that rapidly cause infection. Athlete's foot is a layman's description of a skin fungal infection. It may be associated with several different fungi, including yeasts. The most common fungi causing tinea pedis are ''Trichophyton rubrum'' and ''T. mentagrophytes''. Fungal infections of the skin are called dermatophytosis. Dermatophytes may be spread from other humans (anthropophilic), animals (zoophilic) or may come from the soil (geophilic). Anthropophillic dermatophytes are restricted to human hosts and produce a mild, chronic inflammation. Zoophilic organisms are found primarily in animals and cause marked inflammatory reactions in humans who have contact with infected cats, dogs, cattle, horses, birds, or other animals. Geophilic species are usually recovered from the soil but occasionally infect humans and animals. They cause a marked inflammatory reaction, which limits the spread of the infection and may lead to a spontaneous cure but may also leave scars. Infections or infestations occur when dermatophytes grow and multiply in the skin.

Symptoms

Intertrigo between toes

Athlete's foot causes scaling, flaking and itching of the affected skin. Blisters and cracked skin may also occur, leading to exposed raw tissue, pain, swelling and inflammation. The infection can be spread to other areas of the body, such as the armpits, knees, elbows, and the groin, and usually is called by a different name once it spreads (such as tinea cruris or jock itch for an infection of the skin and groin).

Transmission

Transmission from person to person

Athlete's foot is caused by a parasitic fungus and is a communicable disease Causes of athlete's foot, at WebMD. It is typically transmitted Athlete's foot at Mayo Clinic Health Center in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms. It can also be transmitted by sharing footwear with an infected person, or less commonly, by sharing towels with an infected person.

Transmission to other parts of the body

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 (jock itch).

Prevention

The practices given in this section not only help prevent spread of the disease, they can also help greatly in managing and curing the disease in an individual by reducing or eliminating re-exposure to the fungus in one's home environment.

Prevention measures in the home

The fungi that cause athlete's foot live on moist surfaces and can be transmitted from an infected person to members of the same household through secondary contact "Athlete's Foot, Toe Fungus a Family Affair", Robert Preidt, HealthDay News, September 29, 2006. Quoting the article, "Researchers used advanced molecular biology techniques to test the members of 57 families and concluded that toenail fungus and athlete's foot can infect people living in the same household.". By controlling the fungus growth in the household, transmission of the infection can be prevented. Also you need to dry your toes very well because the fungi can only spread in damp areas.

Bathroom hygiene

Spray tub and bathroom floor with disinfectant after each use to help prevent reinfection and infection of other household members.

Frequent laundering

Wash sheets, towels, socks, underwear, and bed clothes in hot water (at 60 °C / 140 °F) to kill the fungus. Change towels and bed sheets at least once per week.

Avoid sharing

Avoid sharing of towels, shoes and socks between household members.

Prevention measures in public places

★ Wear shower shoes or sandals in locker rooms, public showers, and public baths.

★ Wash feet, particularly between the toes, with soap and dry thoroughly after bathing or showering.

★ If you have experienced an infection previously, you may want to treat your feet and shoes with over the counter anti-fungal sprays after using public facilities.

Personal prevention measures

★ Try to limit the amount that your feet sweat by wearing open-toed shoes when possible and by removing your shoes when at home.

★ Keep shoes dry by wearing a different pair each day.

★ Change socks and shoes after exercise.

Diagnosis

Diagnosis can be performed by a general practitioner or by a specialist (either a dermatologist or podiatrist).
Although athlete's foot can usually be diagnosed by visual inspection of the skin, the diagnosis should always include direct microscopy of a potassium hydroxide preparation (known as a KOH test) at the start of treatment to rule out other possible causes, such as eczema or psoriasis Trends in the treatment of dermatophytosis, , Amalia, del Palacio, Biology of Dermatophytes and other Keratinophilic Fungi, . A KOH preparation is performed on skin scrapings from the affected area. The KOH preparation has an excellent positive predictive value, but occasionally false negative results may be obtained, especially if treatment with an anti-fungal medication has already begun Dermatology for the practicing allergist: Tinea pedis and its complications, , Muhannad, Al Hasan, Clinical and Molecular Allergy, .
A microbiological culture of skin scrapings can be used in diagnosis, but the process takes several weeks and can often give false negative results.
If the above diagnoses are inconclusive or if a treatment regimen has already been started, a biopsy of the affected skin (i.e. a sample of the living skin tissue) can be taken and histological examination of the tissue performed.
A Wood's lamp, although useful in diagnosing fungal infections of the hair (Tinea capitis), is not usually helpful in diagnosing tinea pedis since the common dermataphytes that cause this disease do not fluoresce under ultraviolet light . However, it can be useful for determining if the disease is due to a non-fungal source.

Treatments

Since the fungus thrives in a moist warm environment keeping the feet dry and cool can cure the infection. It is recommended to wear open sandals, or even better, walking barefoot as much as possible. ^[1]
However you should avoid walking barefoot in warm moist environments since you may infect other people, and allowing your feet to stay wet can help the fungus grow.
Keep the feet clean, but make sure they are fully dry after washing them. This may require showering in the evening instead of the morning, and staying barefoot afterwards. Drying between the toes after bathing or showering can get rid of the moist damp environment that the fungus will continue to thrive in. Drying feet and shoe soles with a hairdryer on cold setting works well.
Change socks daily, and try to alternate shoes on different days, to allow the shoes to fully dry out. Spray shoes with over-the-counter anti-fungal athlete's foot products after each use.
Spray tub and bathroom floor with disinfectant after each use to help prevent reinfection and infection of other household members.
Washing sheets, towels, socks, underwear, and bed clothes at 60 °C (140 °F) will also help prevent any reinfection. Change towels and bed sheets at least once per week.
Placebo controlled studies report that good foot hygiene alone can cure athlete's foot even without medication in 30-40% of the cases. ^[2]

Conventional treatments

The infection is often treated with topical antifungal agents such as miconazole, itraconazole, terbinafine, ketaconazole, sertaconazole, and a keratolytic such as salicylic acid. Topical agents only clear the infection about 30% of the time and provide mycologic cures (absence of organisms) less than 15% of the time. The time line for cure may be long, often 45 days or longer. However, because the itching associated with the infection subsides quickly, patients may not complete the courses of therapy prescribed. DO NOT use anti-itch cremes as they will alleviate the symptoms but will exacerbate the fungus.
Some topical applications such as Castellani's Paint, often used for intertrigo, work well but in small selected areas. Carbol Fuscin Red dye used in this treatment like many other vital stains is both fungicidal and bacteriocidal; however, because of the staining are cosmetically undesirable. For many years gentian violet was also used for interdigital and other bacterial and fungal infections.
Oral treatment with griseofulvin was begun early in the 1950s. Because of the tendency to cause liver problems and to provoke aplastic anemia the drugs were used cautiously and sparingly. Over time it was found that those problems were due to the size of the crystal in the manufacturing process and microsize and now ultramicrosize crystals are available with few of the original side effects. Oral treatment provides long lasting mycologic cure.
If the fungal invader is not a dermatophyte but a yeast, other medications such as fluconazole may be used. Typically diflucan is used for candidal vaginal infections moniliasis but has been shown to be of benefit for those with cutaneous yeast infections as well. The most common of these infections occur in the web spaces (intertriginous) and at the base of the fingernail or toenail. The hall mark of these infections is a cherry red color surrounding the lesion and a yellow thick pus.
Undecylenic acid (Castor oil derivative) is an effective fungicide for fungal skin infections such as athlete's foot.

Alternative treatments

Topical oils

Users report instant relief from itching after topical application of tea tree oil or crocodile oil, allowing lesions to heal due to the cessation of scratching the itch.^[3]. Moreover, Tea tree oil is a known antifungal agent.

Household bleach (sodium hypochlorite)

Users report that household bleach (sodium hypochlorite) is a very effective treatment for killing athlete's foot.
Typically bleach is added to a tub or pail of water and then the feet are soaked from 5 to 15 minutes.
Apply a 3% solution directly to the affected area 2 times a day for 2 days.
Thoroughly wash the affected area after 5 minutes of contact.

Rubbing alcohol and hydrogen peroxide

Direct application of rubbing alcohol and/or hydrogen peroxide after bathing can aid in killing the fungus at the surface level of the skin and will help prevent a secondary (bacterial) infection from occurring.

Hair dryer

Since fungi grow in moist conditions, it is very important to dry the feet well after bathing. A hair dryer can be used to aid the drying process.

Origin of the term "athlete's foot"

W. F. Young, Inc. claims that the term "athlete's foot" was originated during an advertising campaign for Absorbine Jr. during the 1930s The Story of W. F. Young, Inc. and Absorbine at the Absorbine website.. However, the Oxford English Dictionary documents the first known written usage as occurring in 1928 ('1928' ''Lit. Digest'' 22 December. 16/1), making the claim doubtful.

Footnotes

1. Athlete's foot
2. Over-the-Counter Foot Remedies (American Family Physician)
3. Over-the-Counter Foot Remedies (American Family Physician)

External links

''Links are organized by subsection, and then listed in alphabetical order.''

General medical information

Photos

★ Photos of Tinea Pedis at DermAtlas

★ Global Skin Atlas. Type "tinea pedis" in search engine.

Organizations

★ American Academy of Dermatology

★ American Podiatric Medical Association

★ Skincell International Forum.''SkinCell International Forum has been established with the intention of bringing together skin disorder sufferers, their friends or family in a relaxed, light-hearted and supportive environment.''

★ Society of Chiropodists and Podiatrists

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