Tinea - Symptoms, Causes, Treatments Tinea Treatments What is tinea? Tinea, commonly referred to as ringworm, is a broad term used to describe a fungal infection of the skin (dermatophyte), whether affecting the body (tinea corporis), the scalp (tinea capitis), the groin (tinea cruris, or jock itch), the feet (tinea pedis, or athlete’s foot), or the nails (tinea unguium, or onychomycosis). While tinea is seen most frequently in children, it occurs in all age groups. Although ringworm is the term most frequently encountered, the infecting agent is actually a fungus that thrives in warm, moist areas and is most likely to occur with constant moisture from perspiration or as a complication of minor injuries to your nails, scalp or skin. The name ringworm comes from a ring-like pattern frequently seen with tinea, the development of red patches on the skin that are often redder around the outside (forming the ring), with a more normal skin color in the center. Looking for a Doctor? Search Now Find an Infectious Disease Specialist Tinea is contagious through skin-to-skin contact or through contact with contaminated items.

It is highly treatable, usually clearing up within four weeks of starting treatment, and is not life threatening. 8 Highly Contagious Diseases You Should Know About Keep these eight highly contagious diseases on your radar and find out how to prevent them. While tinea is a condition requiring prompt attention, it is not an emergency. At the same time, left untreated, it can become complicated by a more widespread bacterial infection. Seek prompt medical care if you are being treated for tinea but symptoms recur or persist after four weeks of care, if it spreads to your scalp or beard, or if you see signs of a bacterial infection developing, marked by symptoms such as swelling in the affected area, skin that is warm to the touch, an increase in redness, pus or discharge, fever, or streaks of red along the skin, particularly on a limb. Tinea Infections - familydoctor.org Tinea Infections Overview What is tinea? Tinea is a fungus that can grow on your skin, hair or nails. As it grows, it spreads out in a circle, leaving normal-looking skin in the middle. This makes it look like a ring. At the edge of the ring, the skin is lifted up by the irritation and looks red and scaly.

To some people, the infection looks like a worm is under the skin. Because of the way it looks, tinea infection is often called "ringworm." However, there really isn’t a worm under the skin. Symptoms What areas of the body are affected by tinea infections? Tinea infections are named for the part of the body they infect. Tinea corporis is a fungal infection of the skin on the body. ("Corporis" is the Latin word for body.) If you have this infection, you may see small, red spots that grow into large rings almost anywhere on your arms, legs or chest. The rash may also itch. Tinea pedis is usually called "athlete’s foot." ("Pedis" is the Latin word for foot.) The moist skin between your toes is a perfect place for a fungus to grow. The skin may become itchy and red, with blisters and cracking of the skin. The infection may also spread to the toenails. (This is called tinea unguium — "unguium" comes from the Latin word for nail.) Here it causes the toenails to become thick and crumbly. It can also spread to your hands and fingernails.

When a fungus grows in the moist, warm area of the groin, the rash is called tinea cruris. ("Cruris" comes from the Latin word for for leg.) The common name for this infection is "jock itch." The rash can be itchy and painful. Tinea cruris generally occurs in men, especially if they often wear athletic equipment. Tinea capitis, which is called "ringworm," causes itchy, red areas, usually on the head. ("Capitis" comes from the Latin for head.) The hair is destroyed, leaving bald patches. This tinea infection is most common in children. Causes & Risk Factors How did I get a fungal infection? You can get a fungal infection by touching a person who has one. Some kinds of fungi live on damp surfaces, like the floors in public showers or locker rooms. You can easily pick up a fungus there. You can even catch a fungal infection from your pets. Dogs, cats and farm animals can be infected with a fungus. Often this infection looks like a patch of skin where fur is missing. Diagnosis & Tests How do I know if I have a fungal infection? The best way to know for sure is to ask your doctor.

Other skin problems can look similar to a fungal infection but require very different treatments. To find out exactly what is causing your rash, your doctor may scrape a small amount of the irritated skin onto a glass slide (or clip off a piece of nail or hair). Then he or she will look at the skin, nail or hair under a microscope. After doing this, your doctor will usually be able to tell whether your skin problem is caused by a fungus. Sometimes a piece of your skin, hair or nail will be sent to a lab to grow the fungus in a test tube. This is another way the lab can tell if your skin problem is caused by a fungus. They can also find out the exact type of fungus. This process takes a while because a fungus grows slowly. Treatment How do I get rid of a tinea infection? Once your doctor decides that you have a tinea infection, antifungal medicine can be used to treat it. You may only need to put an antifungal cream on the rash for a few weeks. This is especially true for jock itch. It can be harder to get rid of fungal infections on other parts of the body. Sometimes you have to take an antifungal medicine by mouth.

This medicine usually has to be taken for a long time, maybe even for months. Irritated skin takes time to heal. New hair or nails will have to grow back. Some medicines can have unpleasant effects on the rest of your body, especially if you’re also taking other medicines. There are some newer medicines that seem to work better with fewer side effects. Talk with your doctor about which medicine is right for you. Complications Can tinea cause serious illness? A fungus rarely spreads below the surface of the body to cause serious illness. Your body usually prevents this. However, people who have weak immune systems, such as people who have HIV or AIDS, may have a hard time getting rid of a fungal infection. Tinea infections usually don’t leave scars after the fungus is gone. Sometimes, people don’t even realize they have a fungal infection and get better without any treatment. Prevention What can I do to prevent tinea infections? Keeping your skin clean and dry is your best defense. However, you’re also less likely to get a tinea infection if you do the following things: When you’re at home, take your shoes off and expose your feet to the air. Change your socks and underwear every day, especially in warm weather.

Dry your feet carefully (especially between the toes) after using a locker room or public shower. Avoid walking barefoot in public areas. Instead, wear flip-flops, sandals or water shoes. Don’t wear thick clothing for long periods of time in warm weather. It will make you sweat more, which can encourage the growth of fungal infections. Throw away worn-out exercise shoes. Never borrow other people’s shoes. Don’t let other people use your towels or wear your clothing. Don’t borrow these items from others. Check your pets for areas of hair loss. Ask your veterinarian to check them, also. It’s important to check pets carefully, because if you don’t find out whether they’re causing your fungal infection, you may get it again from them, even after treatment. Make sure shared exercise equipment (such as a treadmill at your gym) is clean before you use it. Questions to Ask Your Doctor How did I get the infection? What is the best treatment for me? Will I have to use an ointment? How can I avoid getting more tinea infections? My child has to take showers after gym class. How can I keep him/her from getting tinea infections?

If I have cracks in my skin, should I use a topical antbiotic ointment? Once I’m treated for ringworm, will my hair grow back? I have ringworm. Should I wash my sheets and towels every day? Citations Diagnosis and Management of Common Tinea Infections by SL Noble, Pharm.D., RC Forbes, M.D. and PL Stamm, Pharm.D.( 07/01/98, Last Updated: April 2014 Tinea Pedis (Athlete’s Foot) – Pictures, Symptoms, Infection and Treatment Home > Skin, Hair and Nails > Tinea Pedis (Athlete’s Foot) – Pictures, Symptoms, Infection and Treatment Tinea Pedis (Athlete’s Foot) – Pictures, Symptoms, Infection and Treatment Page Contents 12 Pictures of Athlete’s Foot (Tinea Pedis) Tinea Pedis is a common condition that is characterized by inflammation and flaking of the feet. Know all about the causes, symptoms, diagnosis, treatment and preventive measures of this disease. There are also some useful Tinea Pedis photos that you may look at for reference. What Is Tinea Pedis?

It is a disease caused by fungal infection of the feet. The medical term âTinea Pedisâ literally means âringworm of the feetâ. The infection generally affects the feet but may spread to other parts of the body such as the groin. Picture 1 – Tinea Pedis Source – your-lifestyleonline The condition is also known as âAthleteâs Footâ or âTinea of the footâ. Other medical terms for this condition are Interdigitalis, Dermatophytosis Palmaris and Plantaris. The nameÂ âInterdigitalisâ indicates that the condition may also affect the palms of hands other than the toes and soles of feet. Symptoms of Tinea Pedis Some of the main symptoms of Tinea Pedis are Scales or flakes on feet Cracks or blisters over skin of feet Itching and burning sensation in a localized region Redness and inflammation of the toe Exposure of raw tissue Peeling of skin in a particular area These symptoms can arise in the toes as well in other regions of the body such as palms, heels and in the spaces between the fingers.

The condition may also lead to the thickening, crumbling and discoloration of the nails. This generally happens if the fungus spreads to the nails. What Causes Tinea Pedis Infection? The human body consists of a large number of microbes, such as fungi and bacteria. Some of these are beneficial to the physical system and may assist in bodily functions, such as the intestinal bacteria. Athleteâs Foot occurs when there is a rapid multiplication of a certain kind of fungus in the body. The fungus grows especially between the toes. In some cases, there may also be an overgrowth of fungus in the hands. Athleteâs Foot is the most common type of fungal infection that is popularly known as Tinea infection. The condition is commonly caused by the dermatophyte Trichophyton rubrum. Tinea Pedis Diagnosis The diagnosis of Tinea Pedis is mainly based on the appearance of the skin of the affected region. However, medical tests may be performed in cases where rise of many symptoms makes diagnosis difficult. Such tests include Skin Lesion Biopsy Biopsy involves examining a sample of Tinea Pedis blisters under the microscope. Microscopic examination helps reveal presence of fungus in the sample.

This proves a fungal infection of the region. Skin Culture In this process, skin scrapings are collected and examined under a microscope. If fungus is present, testing may help show it. KOH Examination Scrapings of skin lesions are collected and examined to detect presence of fungus. Tinea Pedis Treatment The treatment of Tinea Pedis involves use of antifungal creams and powders that are available over-the-counter. These usually contain tolnaftate, clotrimazole and miconazole. The medicine should be continued for one to two weeks even after the infection has resolved. Continued use prevents recurrence of the infection. Acute infection of the foot does not go away with over the counter cure or home remedies. In case of severe infections that persist for two to four weeks, stronger treatment is needed. Antifungal medicines such as topical drugs like Terbinafine or Ketoconazole may be used for Athleteâs Foot treatment. If secondary bacterial infections arise along with fungal attack, as commonly happens due to scratching the infected region, antibiotics may be used in treatment for Tinea Pedis. Tinea Pedis Home Remedy Some of the common Tinea Pedis home remedies are Cleanliness of feet Moist feet increase chance of fungal infection.

Keeping the feet dry and clean can make you recover faster from this infectious condition. Regularly wash your feet with soap and water. Do not wear socks or shoes immediately after bathing. Allow your feet time to dry before putting on shoes. Avoid tight fitting clothes Avoid using socks and clothes that are tight for your body. Tight garments and socks refuse air drying of sweat and a moist body provides the perfect environment for fungal growth. Tinea Pedis Risk Factors The fungus typically affects people who walk barefoot in moist areas. It can also infect a person in bathhouses and showers. People who do not dry their feet well or wear tight-fitting trainers commonly suffer from this problem. Walking barefoot over wet, warm surfaces such as locker room floors and shower stalls can increase chances of catching this infection. Diabetics and people with weakened immunity are also susceptible to this disorder. Is Tinea Pedis Contagious? Athleteâs Foot is an extremely contagious condition. Once a person has been infected by Trichophyton fungus, he or she can easily transmit it to another person. Tinea Pedis Prognosis Mild cases of the condition respond well to treatment and usually last only for a short time.

Severe cases can take a longer time to resolve. Preventive measures as well as long-term medical care are required to cure persisting cases of Athleteâs Foot. In the absence of care, the infection may persist or come back after some time. Tinea Pedis Complications Some of the possible complications that this condition may produce include Recurrence of the infection Secondary bacterial infections like Cellulitis Chronic Tinea Pedis Use of medications for treatment of this disease may also give rise to complicated side effects. Tinea Pedis Prevention This discomforting syndrome can be avoided by following these simple preventive measures. Drying the feet Allowing air-drying of feet after swimming or bathing can be effective in keeping fungal infection at bay. Wearing sandals Wearing flip-flops or sandals at public pools or showers can avoid fungal infection of the toe. Microbial organisms like bacteria and fungus are usually common in public areas. Use antifungal powders Sprinkle drying or antifungal powders on the toes and soles of your feet before putting on shoes or immediately after coming back from a public shower or pool. Pictures of Athlete’s Foot (Tinea Pedis) Want to get a visual idea about the appearance of the condition?

Here are some useful pictures of Tinea Pedis. Check out these Tinea Pedis images to know how a foot affected with this disorder looks like. Picture 2 – Tinea Pedis Image Source – dartmouth Picture 3 – Tinea Pedis Photo Source – boots With proper care and effective medical cure, there is excellent prognosis of Tinea Pedis. If you notice redness and inflammation of your feet and find them warm to touch, contact a doctor immediately. Early diagnosis and treatment will help you make a faster recovery from this disease. References: Hygiene-related Diseases | Hygiene-related Diseases | Hygiene | Healthy Water | CDC Hygiene-related Diseases To receive email updates about this page, enter your email address: Enter Email Address ShareCompartir Athlete’s Foot (tinea pedis) Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a variety of different fungi. Although tinea pedis can affect any portion of the foot, the infection most often affects the space between the toes. Athlete’s foot is typically characterized by skin fissures or scales that can be red and itchy.

Tinea pedis is spread through contact with infected skin scales or contact with fungi in damp areas (for example, showers, locker rooms, swimming pools) (1) . Tinea pedis can be a chronic infection that recurs frequently (2) . Treatment may include topical creams (applied to the surface of the skin) or oral medications (3) . Appropriate hygiene techniques may help to prevent or control tinea pedis. The following hygiene techniques should be followed: Prevention of athlete’s foot: Nails should be clipped short and kept clean. Nails can house and spread the infection. Avoid walking barefoot in locker rooms or public showers (wear sandals). For control of athlete’s foot infection, persons with active tinea pedis infection should: Keep feet clean, dry, and cool. Avoid using swimming pools, public showers, or foot baths. Wear sandals when possible or air shoes out by alternating them every 2-3 days. Avoid wearing closed shoes and wearing socks made from fabric that doesn’t dry easily (for example, nylon). Treat the infection with recommended medication. For more information on fungal skin infections, visit CDC’s dermatophytes page. American Academy of Pediatrics Redbook.

2006 Report of the Committee on Infectious Diseases, 27th edition. Gupta A et al. Optimal Management of Fungal Infections of the Skin, Hair, and Nail. Am J Clin Dermatol 2004;5(4):225-237. Gupta A et al. Treatments of tinea pedis. Dermatol Clin 2003;21:431-463. Healthy Water Sites Tinea Pedis - National Library of Medicine - PubMed Health Oral antifungal drugs for treating athlete's foot (tinea pedis) Athlete's foot (tinea pedis) is a fungal infection of the feet that is easily spread and difficult to get rid of. This review compared different oral antifungal drugs (i.e. drugs taken by mouth), and it included 15 trials, involving 1438 participants. There are several different kinds of oral treatments, and the trials we found considered all the oral drugs used to treat athlete's foot. We found terbinafine and itraconazole to be more effective than placebo.

And we found terbinafine to be more effective than griseofulvin. Griseofulvin is a treatment that was developed much earlier than the new treatments, such as terbinafine and itraconazole; these newer treatments tend to be most evaluated. Trials of other drugs were not large enough to show differences between them. All drugs had side‐effects; gastrointestinal effects were the most common. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. BACKGROUND: Effective treatment of tinea pedis and onychomycosis is crucial for patients with diabetes as these infections may lead to foot ulcers and secondary bacterial infections resulting in eventual lower limb amputation. Although numerous studies have assessed the effectiveness of antifungal drug and treatment regimens, most exclude patients with diabetes and examine otherwise healthy individuals. While these studies are useful, results cannot necessarily be extrapolated to patients with diabetes. The purpose of this study was to therefore identify the best evidence-based treatment interventions for tinea pedis or onychomycosis in people with diabetes.

Oral antifungal drugs for treating athlete's foot (tinea pedis) Athlete's foot (tinea pedis) is a fungal infection of the feet that is easily spread and difficult to get rid of. This review compared different oral antifungal drugs (i.e. drugs taken by mouth), and it included 15 trials, involving 1438 participants. There are several different kinds of oral treatments, and the trials we found considered all the oral drugs used to treat athlete's foot. We found terbinafine and itraconazole to be more effective than placebo. And we found terbinafine to be more effective than griseofulvin. Griseofulvin is a treatment that was developed much earlier than the new treatments, such as terbinafine and itraconazole; these newer treatments tend to be most evaluated. Trials of other drugs were not large enough to show differences between them. All drugs had side‐effects; gastrointestinal effects were the most common. Athlete's foot: Overview Nearly everyone has had experience with athlete’s foot. The warm and moist spaces between our toes are the perfect place for fungi to grow and spread, typically causing skin redness and cracking.

It can be treated effectively with creams, gels and sprays. We provide information on the various treatments. How effective are athlete's foot treatments? Athlete's foot is very common and usually does not cause any serious problems. But affected skin can crack, and be itchy and unattractive. The fungus can spread to the nails, and on rare occasions to other areas of skin. The infection can usually be treated effectively with creams, gels or sprays.Athlete's foot fungi grow particularly well in the areas between our toes. It is often moist and warm there, and the skin on our feet is also a good breeding ground for fungus. Topical treatment will usually clear up the infection within a few weeks. Tablets only have to be taken in exceptional cases.Good hygiene is also important so that other people do not become infected and to prevent the infection from returning. That includes regularly changing socks, towels and bedding and washing them at over 60 degrees Celsius.

Topical Treatment of Common Superficial Tinea Infections - American Family Physician Topical Treatment of Common Superficial Tinea Infections ANDREW WEINSTEIN, M.D., M.P.H., and BRIAN BERMAN, M.D., PH.D., University of Miami School of Medicine, Miami, Florida Am Fam Physician. 2002 May 15;65(10):2095-2103. References Tinea infections are superficial fungal infections caused by three species of fungi collectively known as dermatophytes. Commonly these infections are named for the body part affected, including tinea corporis (general skin), tinea cruris (groin), and tinea pedis (feet). Accurate diagnosis is necessary for effective treatment. Diagnosis is usually based on history and clinical appearance plus direct microscopy of a potassium hydroxide preparation. Culture or histologic examination is rarely required for diagnosis. Treatment requires attention to exacerbating factors such as skin moisture and choosing an appropriate antifungal agent. Topical therapy is generally successful unless the infection covers an extensive area or is resistant to initial therapy. In these cases, systemic therapy may be required.

Tinea corporis and cruris infections are usually treated for two weeks, while tinea pedis is treated for four weeks with an azole or for one to two weeks with allylamine medication. Treatment should continue for at least one week after clinical clearing of infection. Newer medications require fewer applications and a shorter duration of use. The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent. The latter agents should be used with caution because of their potential for causing atrophy and other steroid-associated complications. Tinea infections are superficial fungal infections caused by the three genera of dermatophytes, Trichophyton, Microsporum and Epidermophyton. 1 Commonly, the infections caused by these organisms are named for the sites involved. Tinea capitis refers to a dermatophyte infection of the head, tinea barbae affects the beard area, tinea corporis occurs on the body surface, tinea manuum is limited to the hands, tinea pedis to the feet, and tinea unguium infects the toenails.

These names do not distinguish between species (for example, tinea capitis may be caused by Trichophyton or Microsporum genera). With some pertinent exceptions, dermatomycosis is typically confined to the superficial keratinized tissue 2 and, thus, can often be treated with topical antifungal medications. 3 Because these agents do not penetrate hair or nails, tinea capitis, tinea barbae, and tinea unguium usually require systemic therapy. This article focuses on the diagnosis and treatment of tinea infections with topical medications. Because tinea capitis and tinea unguium are not typically amenable to topical therapy, they will not be discussed in this article. It is important to note that nondermatophytes and yeasts may infect the sites mentioned above. For example, tinea unguium is only a subset of the onychomycoses, which include other types of fungal infections of the nails. Similarly, tinea corporis refers only to dermatophyte infection of the skin and not other superficial fungal infections such as candidiasis.

Although tinea versicolor is commonly called a tinea, it is caused by the non-dermatophyte Malassezia furfur (also referred to as Pityrosporum orbiculare and Pityrosporum ovale) and is not a true tinea infection. 4 Epidemiology References Because tinea infections are highly common, it is likely that the primary care physician will frequently treat affected patients. The estimated lifetime risk of acquiring dermatophytosis (tinea infection) is between 10 and 20 percent. 5 In the United States, dermatophytosis is second only to acne as the most frequently reported skin disease. 6 The majority of superficial fungal infections are tineas and, of those, the most common are tinea pedis, tinea corporis, and tinea cruris. 7 Trichophyton rubrum is the most likely agent in these dermatomycoses. T. rubrum accounted for 76.2 percent of all superficial fungal diseases in a representative sample of the U.S. population. 8 With the exception of tinea capitis (in which Trichophyton tonsurans was the most likely etiologic agent), T.

rubrum was the most common dermatophyte isolated in all superficial fungal diseases studied. 8 Clinical Manifestations References Clinical presentation is the most important clue to accurate diagnosis and treatment. The anthrophilic dermatophytes (commonly isolated from human infection) are the most common source of human dermatomycoses. These tend to evoke a limited host response and are less likely to be accompanied by severe inflammation or to clear spontaneously. 9 Occasionally, severe inflammation is a component of dermatophytosis. This is particularly true in the case of tinea infections caused by zoophilic species (commonly isolated from animal infection). The most common of these is Microsporum canis. TINEA CORPORIS Tinea corporis refers to tinea anywhere on the body except the scalp, beard, feet, or hands. This lesion presents as an annular plaque with a slightly raised and often scaly, advancing border and is commonly known as ringworm. Each lesion may have one or several concentric rings with red papules or plaques in the center. As the lesion progresses, the center may clear, leaving post-inflammatory hypopigmentation or hyperpigmentation.

TINEA CRURIS Because it affects the groin area, tinea cruris is also known as “jock itch.” It is characterized by red scaling plaques on the medial thighs and inguinal folds ( Figure 1 ). The plaques are typically bilateral but usually spare the penis and scrotum, in contrast to candidiasis. 10 Many people with tinea cruris have coincident tinea pedis, and it has been postulated that the tinea cruris is spread by hand from the tinea pedis. 11 Tinea cruris with bilateral scaly patches on the inner thighs, sparing the penis. FIGURE 1. Tinea cruris with bilateral scaly patches on the inner thighs, sparing the penis. TINEA PEDIS Tinea pedis, or athlete's foot, is the most common dermatophyte infection ( Figure 2 ). Its etiology is closely tied to the use of occlusive footwear. 12 Most commonly, tinea pedis presents with toe-web maceration. 13 This fairly subtle presentation is contrasted with the moccasin distribution affecting the soles and lateral feet that is often seen in patients with T. rubrum infection ( Figure 3 ).

In the latter cases, the feet tend to be hyperkeratotic with scale and some erythema ( Figure 4 ). In some cases of tinea pedis, a dermatophytid (also known as “id”) reaction may occur in which small vesicles or pustules appear at distant sites. The id reaction may be the only manifestation of an otherwise asymptomatic webspace maceration and usually resolves with treatment of the primary fungal infection. View/Print Figure FIGURE 2. Tinea pedis presenting with toe-web maceration and minimal inflammation. A presentation like this may be accompanied by a dermatophytid (“id”) reaction. FIGURE 2. Tinea pedis presenting with toe-web maceration and minimal inflammation. A presentation like this may be accompanied by a dermatophytid (“id”) reaction. Moccasin distribution of tinea pedis with inflammation. FIGURE 3. Tinea pedis with marked erythema of the first and second toes. FIGURE 4. Tinea pedis with marked erythema of the first and second toes. Diagnosis References The clinical suspicion of dermatophytosis can be confirmed with diagnostic tests.

Because other entities may mimic tinea infection, treatment should not be initiated on the basis of clinical presentation alone. In most cases, a simple potassium hydroxide (KOH) preparation with mycologic examination under a light microscope can confirm the presence of dermatophytes. Occasionally, culture media (including indicator media) or histologic examination may be useful in making the diagnosis. A Wood's light is not helpful in diagnosing tinea infections of the skin and is mainly used to identify fungal elements in hairs infected with Microsporum, which is a less common dermatophyte. The latter fluoresce green under Wood's light. This light may also be helpful in diagnosing erythrasma by its coral-red fluorescence when this condition is part of the differential diagnosis of a tinea skin condition. 14 KOH Preparation for Direct Microscopy Jump to section + References The KOH preparation, a relatively simple diagnostic method with excellent positive predictive value, is used to visualize the hyphae that characterize dermatophytes. Additional confirmatory tests are rarely needed for the diagnosis of tinea. 15 The KOH helps dissolve the epithelial tissue, allowing the hyphae to be seen on microscopy.

Because the organisms live in the superficial keratinized tissue, a sample of scale should be visualized under low or medium power. Scale is collected from the active border of a lesion. This is done by scraping the lesion with the edge of a rounded scalpel blade or the edge of a glass slide. The debris is collected on another slide and concentrated in the middle. If a vesicle is being examined, it may be unroofed, and that material can be examined. The slide should be covered with a cover slip, and KOH (5 to 20 percent) should be added to the side of the cover slip, allowing capillary action to draw the KOH to the scaly sample. The preparation may be heated gently over a flame to highlight the fungal elements. If dimethyl sulfoxide has been added to the KOH, heating is not required. During examination of the sample, the condenser of the microscope should be in the down position. The presence of septate hyphae confirms the diagnosis of tinea. The examiner should make sure that hyphae are being seen rather than the edge of an epithelial cell. It is helpful to visualize the hyphae crossing the path of more than one cell.

If clinical decisions are to be made based on microscopic examination, practitioners must comply with Clinical Laboratory Improvement Amendments (CLIA) regulations. Performing KOH examinations requires a Provider–Performed Microscopy (PPM) certificate. Obtaining the latter requires completion of paperwork and does not require a site inspection. The American Academy of Dermatology publishes a handbook with directions for compliance with the PPM regulation. 16 Culture References Mycologic culture is rarely indicated in the diagnosis of tineas other than tinea unguium and tinea capitis. In some cases, even though clinical suspicion is high, diagnosis may be a challenge. Culture, while relatively simple to perform, requires one to four weeks to grow and clinical expertise to interpret the result. The most common medium used for isolating dermatophytes is Sabouraud's peptone-glucose agar. 1 Various formulations of this medium are commercially available; some have additives that inhibit bacterial and nondermatophyte growth. 17 A dermatophyte test medium (DTM) indicator can also be used. The latter has the added advantage of a phenol indicator that turns red in the alkaline environment produced by dermatophytes.

18 Although DTM has the advantage of simplicity, it has a high rate of false-positive and false-negative results. 1 All media require collection of an adequate sample of infected material. Scale may be collected in a manner similar to that used for the KOH preparation or with a cotton swab. The swab must first be moistened with sterile water and then rubbed vigorously over the active border of the lesion. This method is best used when the lesion is not scaly or when the use of a blade or slide is impractical. 19 The physician performing the culture must comply with stricter CLIA regulations. Performing cultures requires a level of certification that necessitates a laboratory inspection. HISTOPATHOLOGIC EVALUATION When the diagnosis of a dermatophyte infection remains in question after office testing or failure to respond to treatment, biopsy specimens may be submitted to a pathologist for evaluation. Fungal staining with periodic acid–Schiff highlights fungal elements. 17 Treatment References Most tinea corporis, cruris, and pedis infections can be treated with topical agents. Consideration should be given to systemic treatment when lesions covering a large body-surface area fail to clear with repeated treatment using different topical agents.

3 In treating dermatophytosis, the physician must also address environmental factors that lead to or exacerbate tinea infection and select an appropriate topical therapy for the infection. NONPHARMACOLOGIC MEASURES Because fungi thrive in moist warm environments, patients should be encouraged to wear loose-fitting garments made of cotton or synthetic materials designed to wick moisture away from the surface. Socks should have similar properties. Areas likely to become infected should be dried completely before being covered with clothes. Patients should also be advised to avoid walking barefoot and sharing garments. NONSPECIFIC AGENTS A variety of traditional agents without specific antimicrobial function are still in use, including Whitfield's ointment and Castellani's (carbol fuchsin solution) paint. The efficacy of these preparations has not been well quantified. ANTIFUNGAL AGENTS The antifungal agents can be grouped by structure and mechanism of action. The two principal pharmacologic groups are the azoles and the allylamines. Polyenes (amphotericin B [Fungizone] and nystatin [Mycostatin]) are not discussed in this article because this group of compounds is not effective in the treatment of dermatophyte infections.

Other agents that do not fit into the two main groupings are tolnaftate (Tinactin), haloprogin (Halotex), ciclopirox (Loprox) and butenafine (Mentax). 3 Because there are few direct comparisons of individual topical agents, it can be difficult to justify the choice of one preparation over another. This choice is made less clear because several genera and species may produce the same clinical condition. When treating a dermatophyte infection, it is unlikely that the physician will know the infecting species. In general, tinea corporis and tinea cruris require once- to twice-daily treatment for two weeks. Tinea pedis may require treatment for four weeks. 3 Treatment should continue for at least one week after symptoms have resolved. 17 Some of the newer agents require only once-daily application and shorter courses of treatment, and are associated with lower relapse rates. The application area should include normal skin about 2 cm beyond the affected area. Guidelines regarding the optimal vehicle of treatment (e.g., cream, ointment, gel, or lotion) are given in Table 1 .

20 Ideally, an agent will provide clinical and mycologic cure, symptomatic relief, and low relapse rate, along with ease of use. In addition to specific anti-fungal properties, some preparations have antibacterial and anti-inflammatory properties that may influence their efficacy. Combination therapy (antifungal plus steroid) can be considered when inflammation is an issue. Combination agents should not be used when the diagnosis is in question because that may lead to their overuse or to adverse effects. Common Antifungal Medications and Their Forms Agent Rx = prescription; OTC = over-the-counter; BMD = betamethasone dipropionate. *—Powders and sprays may be used to prevent reinfection. †—Use lotions in intertriginous or hairy areas and on oozing lesions. ‡—Use creams on non-oozing and moderately scaling lesions. §—Use ointments on hyperkeratotic lesions. ||—Ciclopirox lacquer (Penlac) is approved for treatment of onychomycosis but has limited efficacy. Adapted with permission from Diehl KB. Topical antifungal agents: an update.

Am Fam Physician 1996;54:1689. TABLE 1 Common Antifungal Medications and Their Forms Agent Rx = prescription; OTC = over-the-counter; BMD = betamethasone dipropionate. *—Powders and sprays may be used to prevent reinfection. †—Use lotions in intertriginous or hairy areas and on oozing lesions. ‡—Use creams on non-oozing and moderately scaling lesions. §—Use ointments on hyperkeratotic lesions. ||—Ciclopirox lacquer (Penlac) is approved for treatment of onychomycosis but has limited efficacy. Adapted with permission from Diehl KB. Topical antifungal agents: an update. Am Fam Physician 1996;54:1689. The mechanism of action may have an effect on efficacy. The newer agents have fungicidal activity, which may translate into higher cure rates and lower relapse rates. Clinical judgment with regard to prior treatments and complicating conditions (bacterial growth or intense inflammation), along with knowledge of the agent's properties, will help guide the choice of therapy.

When inflammation is a salient clinical feature, it must be considered in the selection of a treatment option. Tolnaftate This narrow-spectrum antifungal has no antibacterial or anticandidal activity. 21 It is effective in most dermatophytoses and for treatment of tinea versicolor. 22 It is available as an over-the-counter medication and requires twice-daily application. Haloprogin Introduced after tolnaftate, haloprogin combines equivalent efficacy with a broadened fungal spectrum (including yeasts). 23 It is associated with higher rates of irritant dermatitis. 24 It is applied twice daily. Ciclopirox This broad-spectrum agent is effective against dermatophytes, yeasts, and some bacteria. 3 It has in vitro antibacterial activity against gram-negative and gram-positive bacteria. It has been shown to be more effective than the nonprescription agent clotrimazole (Lotrimin) in the treatment of tinea pedis. 25 It requires twice-daily application. Ciclopirox 8 percent lacquer (Penlac), which was approved for treatment of onychomycosis in late 1999, has limited efficacy.

In two trials of daily application to infected toenails for 48 weeks, complete cure was achieved in 5.5 and 8.5 percent of patients. Only the latter was statistically significant compared with placebo. Partial clearance was also low (12 percent in the more successful trial). Penlac requires daily application for up to 48 weeks and monthly follow-up for nail debridement. 26 Butenafine This agent is similar in structure to that of the allylamines. Butenafine is fungicidal for dermatophytes in vitro. 27 It is applied once daily and, after four weeks of use, is associated with high cure rates and a long disease-free interval. 28 Azoles This class includes many over-the-counter and prescription preparations. Members of this class include clotrimazole, econazole (Spectazole), ketoconazole (Nizoral), miconazole (Micatin), oxiconazole (Oxistat), and sulconazole (Exelderm). These agents have broad-spectrum activity, including activity against some gram-positive bacteria.

Ketoconazole, 29 sulconazole and oxiconazole 30 require only once-daily application because of their long durability in the superficial layers of the skin. Clotrimazole, miconazole, and econazole require twice-daily application. Allylamines Naftifine (Naftin) and terbinafine (Lamisil) are applied once-daily and remain active in the skin for up to one week after application. 31 , 32 Both agents have fungicidal activity in vitro, but the clinical significance of this point is uncertain. 33 , 34 Terbinafine has been compared with ketoconazole and miconazole. Terbinafine was more efficacious after one week than ketoconazole was after two weeks. 35 In addition, one week of terbinafine was found to be as effective as four weeks of miconazole. 36 Evidence also suggests that terbinafine may be effective in curing tinea pedis in as few as three applications. 37 Naftifine has intrinsic anti-inflammatory properties equivalent to members of the azole class plus 1 percent hydrocortisone.

38 Evidence suggests that the fungicidal activity of naftifine and its duration of activity result in higher cure rates and a lower relapse rate. 39 COMBINED STEROID/ANTIFUNGAL AGENTS In the United States, the only combination steroid/antifungal agent indicated for the treatment of dermatophytosis is clotrimazole-betamethasone (Lotrisone). This formulation combines an effective antifungal agent with a potent steroid. Patients who have symptomatic inflammatory dermatophytosis with erythema, pruritus, and burning are optimally treated twice daily with this combination. The steroid component provides rapid symptomatic relief while the slower-acting antifungal agent eradicates the causative organism. Inflammation typically occurs in tineas caused by zoophilic dermatophytes. The efficacy of this combination treatment has been demonstrated in two randomized controlled studies, 40 , 41 the first treating tinea cruris and the second treating tinea cruris and corporis. In each study, the combination was better than either of the components alone in clearing the tinea infection.

Because of these results, it is inferred that the steroid may enhance the antifungal activity of the clotrimazole. 40 A steroid/antifungal preparation should be used only when a diagnosis of fungal infection has been confirmed, not when it is in question. An analysis of the use of this product found that nondermatologists are more likely to use combination therapy. 42 In the absence of fungi or inflammation, the added expense of this preparation is not justified. Because of the potent steroid component, this medication provides rapid relief, but it must be used judiciously. 43 Potential complications associated with long-term steroid use are atrophy, steroid-induced acne, rosacea, and striae. Caution must be used when treating areas of thin skin and naturally occluded body areas, such as the groin, axillae, breast, and face. Treatment of these areas should be avoided whenever possible. When the groin is affected by dermatophytosis, the cream should be used sparingly and only for two weeks. The recommended duration of treatment for tinea pedis is four weeks. This combination should not be used in children younger than 12 years. Read the full article. Get immediate access, anytime, anywhere.

Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Already a member/subscriber? Already a member or subscriber? Log in Immediate, unlimited access to all AFP content More than 130 CME credits per year Access to the AFP app Print delivery option Immediate access to this issue CME credits in this issue Immediate access to this article To see the full article, log in or purchase access. The Authors show all author info ANDREW WEINSTEIN, M.D., M.P.H., is a resident in the Department of Dermatology and Cutaneous Surgery at the University of Miami School of Medicine. He received his medical degree from the University of Illinois College of Medicine at Urbana-Champaign and a master of public health degree from Florida International University, Miami.... BRIAN BERMAN, M.D., PH.D., is professor in the departments of Dermatology and Cutaneous Surgery, and Internal Medicine at the University of Miami School of Medicine. He received his medical and postdoctoral degrees from New York University School of Medicine, New York. He completed residency training in dermatology at New York University School of Medicine.

Address correspondence to Brian Berman, M.D., Ph.D., Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, P.O. Box 016250 (R-250), Miami, FL 33101. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. REFERENCES show all references 1. Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. 1995;8:240–59.... 2. Dei Cas E, Vernes A. Parasitic adaptation of pathogenic fungi to mammalian hosts. Crit Rev Microbiol. 1986;13:173–218. 3. Gupta AK, Einarson TR, Summerbell RC, Shear NH. An overview of topical antifungal therapy in dermatomycoses. A North American perspective. Drugs. 1998;55:645–74. 4. Roberts SO. Pityriasis versicolor: a clinical and mycological investigation.

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1996;35:539–42. 9. Dahl MV. Suppression of immunity and inflammation by products produced by dermatophytes. J Am Acad Dermatol. 1993;28(5 pt 1):S19–23. 10. La Touche CJ. Scrotal dermatophytosis. An insufficiently documented aspect of tinea cruris. Br J Dermatol. 1967;79:339–44. 11. McAleer R. Fungal infection as a cause of skin disease in Western Australia. Australas J Dermatol. 1980;21:25–46. 12. Philpot CM. Some aspects of the epidemiology of tinea. Mycopathologia. 1977;62:3–13. 13. Habif TP. Superficial fungal infections. In: Clinical dermatology: a color guide to diagnosis and therapy. Habif TP, ed. 3d ed. St. Louis: Mosby, 1996:362–408. 14.

Rasmussen JE. Cutaneous fungus infections in children. Pediatr Rev. 1992;13:152–6. 15. Bergus GR, Johnson JS. Superficial tinea infections. Am Fam Physician. 1993;48:259–68. 16. Kenyon J, ed. Dermatology Practice Administration: CLIA ‘88. American Academy of Dermatology. Chambourg, Ill.: Knapp, 1993. 17. Fitzpatrick TB, Johnson RA, Wolff K, Polano MK, Suurmond D. Cutaneous fungal infections. In: Color atlas and synopsis of clinical dermatology: common and serious diseases. Fitzpatrick TB, et al., eds. 3d ed. New York: McGraw-Hill, 1997:688–733. 18. Taplin D, Zaias N, Rebell G, Blank H. Isolation and recognition of dermatophytes on a new medium (DTM). Arch Dermatol. 1969;99:203–9. 19.

Head ES, Henry JC, Macdonald EM. The cotton swab technic for the culture of dermatophyte infections—its efficacy and merit. J Am Acad Dermatol. 1984;11(5 pt 1):797–801. 20. Diehl KB. Topical antifungal agents: an update. Am Fam Physician. 1996;54:1687–92. 21. Barrett-Bee KJ, Lane AC, Turner RW. The mode of antifungal action of tolnaftate. J Med Vet Mycol. 1986;24:155–60. 22. Weinstein MJ, Oden EM, Moss E. Antifungal properties of tolnaftate in vitro and in vivo. Antimicrob Agents Chemother. 1964;3:595–601. 23. Hermann HW. Clinical efficacy studies of haloprogin, a new topical antimicrobial agent. Arch Dermatol. 1972;106:839–42. 24. Rudolph RL.

Allergic contact dermatitis caused by haloprogin. Arch Dermatol. 1975;111:1487–8. 25. Aly R, Maibach HI, Bagatell FK, Dittmar W, Hanel H, Falanga V, et al. Ciclopirox olamine lotion 1%: bioequivalence to ciclopirox olamine cream 1% and clinical efficacy in tinea pedis. Clin Ther. 1989;11:290–303. 26. Penlac package insert. Dermik Laboratories, 2000. Retrieved May 2001, from: . 27. Nussbaumer P, Dorfstatter G, Grassberger MA, Leitner I, Meingassner JG, Thirring K, et al. Synthesis and structure-activity relationships of phenyl-substituted benzylamine antimycotics: a novel benzylbenzylamine antifungal agent for systemic treatment. J Med Chem. 1993;36:2115–20. 28.

Tschen E, Elewski B, Gorsulowsky DC, Pariser DM. Treatment of interdigital tinea pedis with a 4-week once-daily regimen of butenafine hydrochloride 1% cream. J Am Acad Dermatol. 1997;36(2 pt 1):S9–14. 29. Lester M. Ketoconazole 2 percent cream in the treatment of tinea pedis, tinea cruris, and tinea corporis. Cutis. 1995;55:181–3. 30. Polak A. Antifungal activity of four antifungal drugs in the cutaneous retention time test. Sabouraudia. 1984;22:501–3. 31. Hill S, Thomas R, Smith SG, Finlay AY. An investigation of the pharmacokinetics of topical terbinafine (Lamisil) 1% cream. Br J Dermatol. 1992;127:396–400. 32. Meinicke K, Striegel C, Weidinger G.

Treatment of dermatomycosis with naftifin. Therapeutic effectiveness following once and twice daily administration. Mykosen. 1984;27:608–14. 33. Patel A, Brookman SD, Bullen MU, Marley J, Ellis DH, Williams T, et al. Topical treatment of interdigital tinea pedis: terbinafine compared with clotrimazole. Australas J Dermatol. 1999;40:197–200. 34. Ryder NS. Terbinafine: mode of action and properties of the squalene epoxidase inhibition. Br J Dermatol. 1992;126(suppl 39):2–7. 35. Bonifaz A, Saul A. Comparative study between terbinafine 1% emulsion-gel versus ketoconazole 2% cream in tinea cruris and tinea corporis. Eur J Dermatol. 2000;10:107–9. 36.

Leenutaphong V, Niumpradit N, Tangwiwat S, Sri-taveesuwan R, Muanprasat C. Double-blind study of the efficacy of 1 week topical terbinafine cream compared to 4 weeks miconazole cream in patients with tinea pedis. J Med Assoc Thai. 1999;82:1006–10. 37. Evans EG, Seaman RA, James IG. Short-duration therapy with terbinafine 1% cream in dermatophyte skin infections. Br J Dermatol. 1994:130:83–7. 38. Nada M, Hanafi S, al-Omari H, Mokhtar M, el-Shamy S, Muhlbacher J. Naftifine versus miconazole/hydrocortisone in inflammatory dermatophyte infections. Int J Dermatol. 1994;33:570–2. 39. Smith EB, Breneman DL, Griffith RF, Hebert AA, Hickman JG, Maloney JM, et al.

Double-blind comparison of naftifine cream and clotrimazole/betamethasone dipropionate cream in the treatment of tinea pedis. J Am Acad Dermatol. 1992;26:125–7. 40. Wortzel MH. A double-blind study comparing the superiority of a combination antifungal (clotrimazole)/steroidal (betamethasone dipropionate) product. Cutis. 1982;30:258–61. 41. Katz HI, Bard J, Cole GW, Fischer S, McCormick GE, Medansky RS, et al. SCH 370 (clotrimazole-betamethasone dipropionate) cream in patients with tinea cruris or tinea corporis. Cutis. 1984;34:183–8. 42. Smith ES, Fleischer AB Jr, Feldman SR. Nondermatologists are more likely than dermatologists to prescribe antifungal/corticosteroid products: an analysis of office visits for cutaneous fungal infections, 1990–1994.

J Am Acad Dermatol. 1998;39:43–7. 43. Lotrisone. Package insert. Schering Corporation, Kenilworth, N.J.: 1994. Add/view comments Ringworm Symptoms, Treatment, Causes - Types of ringworm: tinea pedis and tinea unguium. What are the symptoms? - MedicineNet Medical Author: Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology. Medical Editor: William C. Shiel Jr., MD, FACP, FACR William C. Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame.

There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Types of ringworm: tinea pedis and tinea unguium. What are the symptoms? Quick GuideRingworm: Treatment, Pictures, Causes, and Symptoms Types of ringworm: tinea pedis and tinea unguium. What are the symptoms? Tinea pedis: Athlete's foot may cause scaling and inflammation with itching and burning irritation in the toe webs, especially the one between the fourth and fifth toes. Another common form of tinea pedis produces a thickening or scaling of the skin on the heels and soles. This is sometimes referred to as the "moccasin distribution." Occasionally, tinea causes blisters between the toes or on the sole. Aside from athlete's foot, tinea pedis is known as tinea of the foot or, more loosely, fungal infection of the feet. Tinea pedis is an extremely common skin disorder.

It is the most common and perhaps the most persistent of the fungal (tinea) infections. It is rare before adolescence. It may occur in association with other fungal skin infections such as tinea cruris (jock itch). Management of Tinea Pedis - IFD Management of Tinea Pedis Protocols / Management of Tinea Pedis What is tinea pedis? A fungal infection of the feet, most frequently affecting the spaces between toes (interdigital spaces). It is transmitted by human to human contact in warm humid environments, for example through shared towels and on wet floors in swimming pools, changing rooms and gymnasia. Which population is at risk? Adults almost exclusively, with men being more often affected than women. It is particularly prevalent in hot, tropical, urban environments. Most likely to be seen in those who wear shoes. Heavy industrial or military footwear is particularly associated with this infection. It is common in industry where workers share common shower and changing areas. What are the clinical symptoms? 1. Interdigital Most common form of tinea pedis; Scaling, fissured skin in the interdigital spaces, usually the 4th and 5th space; There may be some inflammation; Itch is commonly present; 2.

Vesicular patterns Usually due to T. interdigitale; Causes vesicles between the toes, on the sides and tops of the feet. These may become larger and form blisters. When the lesions burst they leave scales; It is usually extremely itchy. 3. Dry scaly, hyperkeratotic patterns Cover the soles of the feet and extend up around the sides to produce a well demarcated line (moccasin pattern); Small circles of scaling are common; Usually due to T. rubrum; Associated nail disease is very common; How is diagnosis confirmed? Diagnosis is confirmed by skin scraping which is then viewed under a microscope in potassium hydroxide, followed by culture. Generally a clinical diagnosis is sufficient to warrant starting treatment, providing it is recognised that there are other causes of interdigital infection. What might it be confused with? Interdigital fungal infection: Gram negative bacterial infection ( presence of maceration, erosion of the skin, green discolouration and pain rather than itch are all pointers ); interdigital maceration (often present in lymphoedema); soft corns; interdigital erythrasma or Candida infection.

Scytalidium infection - this fungus is common in the tropics, mimics tinea pedis of interdigital and dry scaly types and seldom responds to antifungals. Vesicular pattern: plantar pustular psoriasis or eczema. Hyperkeratotic pattern: psoriasis; eczema, Scytalidium infection ( see above ). What preventive measures should be taken? 1. Preventive approaches are ideal. Patients should be advised: To wash their feet carefully, at least daily, and dry meticulously between the toes. Avoid having sweaty feet by wearing open toed shoes (sandals or flip flops). Which treatments are most effective? A number of topical antifungals will be effective if used correctly for the right amount of time. These include azoles (e.g. ketoconazole, amorolfine and miconazole nitrate), allylamines (e.g. terbinafine) and undecenoic acid. All three broad categories of drug are efficacious. Whilst allylamines are slightly more efficacious at resolving infections than azoles they are more expensive.

Whitfield’s ointment, comprising benzoic acid and salicylic acid in a white soft paraffin base, is a cheap alternative to the branded antifungal preparations. Treatment is longer ( up to 1 month ) It is particularly helpful on dry tinea pedis. If nails are involved or there is extensive plantar scaling oral therapy with terbinafine or itraconazole is preferred. Griseofulvin can be used but is less effective. How should the treatments be used? Exact instructions for use will vary depending on the specific product. In general the following guidelines should be followed: Creams/ointments should always be applied to clean, well dried skin; Enough should be used to cover the area comfortably; The cream/ointment should be rubbed in gently but completely (no white appearance left on the skin); Creams/ointments should be applied for up to two weeks after the symptoms have cleared to reduce the likelihood of a relapse. What are the common concurrent problems? Interdigital bacterial infection caused by Gram neagtive bacteria. described previously can follow tinea pedis. Treatment of one can result in recurrence of the other. Erythrasma due to Cornyebacterim minutissimum .

Early lesions present as asymptomatic areas of interdigital scaling or maceration. Treatment with topical azole antifungals or oral erythromycin is required ; Whitfield’s ointment may also help to resolve these infections. Risk factors are the same as for tinea pedis . It can be differentially diagnosed using a Woods light which will cause bright pink fluorescence. Interdigital cracks of whatever cause create entry lesions for other bacterial infections which can lead to cellulitis/erysipelas and “acute febrile attacks” particularly in people with lymphoedema. What are the uncommon concurrent problems? Multiple itchy vesicles sometimes develop most commonly on sides of fingers, palms and soles, worse closer to the primary infection. This is known as an ‘id’ reaction probably an immunological reaction to the dermatophyte. Treatment should be continued. What are the commonly held misconceptions about the disease? That all interdigital lesions on the feet are always fungal.

Both Gram positive and Gram negative bacterial infections may also present with web lesions; likewise Candida and Scytalidium as well as dermatophyte fungi may all cause web infections Protocols Tinea Pedis - Causes, Symptoms and Treatment Home :: Tinea Pedis Tinea Pedis Tinea pedis is a dermatophytic infection of the feet, characterized by erythema, scaling, maceration, and/or bulla formation. In most cases of epidermal dermatophytosis, the infection occurs initially on the feet, and, in time, spreads to sites such as the inguinal area (tinea cruris), trunk (tinea corporis), hands (tinea manuum). Tinea pedis often provides breaks in the integrity of the epidermis through which bacteria such as Staphylococcus aureus or group A streptococcus can invade causing localized infection or spreading infections such as cellulitis or lymphangitis. Causes of Tinea Pedis Tinea pedis is caused by a fungus that is only mildly contagious. Everyone is exposed to the fungus which causes tinea pedis; why only some people get it is unknown. Tinea pedis may stay in the skin indefinitely.

Even if the rash seems to have been cured, microscopic examination may reveal the fungus to be present. While medicines will clear up the rash, the fungus may merely be "lying low" and may cause the same rash again. Symptoms of Tinea Pedis White Scaly Skin causes an itching on the bottom of the foot and in between the toes. The skin will eventually soften, causing the whitish borders to peel off easily. The center of the lesion may be irritated, red, and in some cases, a watery discharge can be seen. Other types of Tinea Pedis may be the moccasin variety (white, thick, dense and scaly sole), which consists of large areas of cracked skin, inflammation, fluid field vesicles or bullae. White/pink Scaly Skin in the affected areas, with no itching whatsoever. Diagnosis Demonstration of hyphae on direct microscopy, ±isolation of dermatophyte on culture. Treatment Special considerations by type of infection Macerated interdigital Acute: Burow's wet dressings; Castellani's paint. Chronical: aluminum chloride hexahydrate 20% bid to reduce sweating. Inflammatory/bullous Acutely, use cool compresses.

If severe, systemic glucocorticoids are indicated. Antifungal agents Topical See Dermatophytoses . Apply to all affected sites twice daily. Treat for 2-4 weeks Systemic Indicated for extensive infection, for failures of topical treatment, or for those with tinea unguium and moccasin-type tinea. Secondary prophylaxis Important in preventing recurrence of interdigital and moccasin types of tinea pedis. Daily washing of feet while bathing with benzoyl peroxide bar is effective and inexpensive. Antifungal powders. Prevention Use of shower shoes while bathing at home or in public facility. Washing feet with benzoyl peroxide bar directly after shower. Diabetics and those who have undergone coronary artery bypass with harvesting of leg veins are especially subject to secondary bacterial infection (impetiginization, lymphangitis, cellulitis). More Skin Disorders Ringworm Pictures: Rash, Skin Infections, Itching, Home Care, and More 2 / 16 Does Ringworm Mean I Have Worms? No. Ringworm is not caused by a worm. It's a fungal infection that often forms a ring-shaped rash.

It can have a red center (seen here) or normal skin tone inside the ring. Other rashes can look like ringworm, including spider bites, nummular eczema, and Lyme disease, a more serious infection that produces a bull's-eye shaped rash. These require different treatments, so it's important to consult a medical professional. Swipe to advance 3 / 16 What Causes Ringworm? Certain fungi can help the body, but the dermatophyte types that cause ringworm irritate the skin instead. These fungi live off the dead tissues of your skin, hair, and nails. Dermatophytes thrive in warm, moist areas, such as the skin folds of the groin area or between the toes. You’re at greater risk of getting ringworm if you sweat excessively or have minor injuries to your skin, scalp, or nails. Swipe to advance 4 / 16 Ringworm of the Body (Tinea Corporis) There are several types of ringworm (tinea) that can affect different parts of the body. When fungus affects the skin of the body, it often produces itchy, red, raised, scaly patches that may blister and ooze. The patches often have sharply defined edges.

They are often redder around the outside with normal skin tone in the center, creating the appearance of a ring. Your skin may also appear unusually dark or light. Swipe to advance 5 / 16 Ringworm of the Scalp (Tinea Capitis) Ringworm of the scalp commonly affects children in late childhood or adolescence. This condition may spread in schools. Tinea capitis often appears as patchy, scaling bald spots on the scalp. (Other scalp conditions, such as seborrhea or dandruff, do not cause hair loss). Swipe to advance 6 / 16 Ringworm of the Foot (Tinea Pedis) Tinea pedis is an extremely common skin disorder, also known as athlete's foot. This fungal infection may cause scaling and inflammation in the toe webs, especially the one between the fourth and fifth toes. Other symptoms include itching, burning, redness, and stinging on the soles of the feet. Swipe to advance 7 / 16 Ringworm of the Groin (Tinea Cruris) Tinea of the groin (jock itch) tends to have a reddish-brown color and may extend from the folds of the groin down onto one or both thighs.

Jock itch occurs mostly in adult men and adolescent boys. (Other conditions that can mimic tinea cruris include yeast infections, psoriasis, and intertrigo.) Jock itch may occur due to sweating, hot and humid weather, or friction from wearing tight clothes. Swipe to advance 8 / 16 Ringworm of the Beard (Tinea Barbae) Ringworm of the bearded area of the face and neck, with swellings and marked crusting, sometimes causes the hair to break off. In the days when men went to the barber daily for a shave, tinea barbae was called barber's itch. Swipe to advance 9 / 16 Ringworm of the Face (Tinea Faciei) Ringworm on the face outside of the beard area is called tinea faciei. On the face, ringworm is rarely ring-shaped. Characteristically, it causes red, scaly patches with indistinct edges. Swipe to advance 10 / 16 Ringworm of the Hand (Tinea Manus) Ringworm may involve the hands, particularly the palms and the spaces between the fingers. It typically causes thickening (hyperkeratosis) of these areas, often on only one hand.

Tinea manus is a common companion of tinea pedis (ringworm of the feet). It is also called tinea manuum. Swipe to advance 11 / 16 Ringworm of the Nails (Tinea Unguium) Ringworm is the most common fungal infection of the nails, also called onychomycosis. It can make fingernails look white, thick, opaque, and brittle, but more often toenails look yellow, thick, and brittle. Artificial nails increase the risk for tinea unguium as emery boards can carry infection, and water can collect under the artificial nail, creating a moist area for fungal growth. Swipe to advance Ringworm is highly contagious and can be spread multiple ways. You can get it from an infected person, animal, object, and even soil. Heat and moisture help fungi grow and thrive, which makes them more common in areas where you sweat. Fungi also grows in skin folds such as those in the groin or between the toes. Swipe to advance 13 / 16 Catching Ringworm From Pets Ringworm is an example of a zoonotic disease (transmitted from animals to humans). Cats are among the most commonly affected animals.

If a cat has ringworm, a person in the house often gets the infection. Dogs, cows, goats, pigs, and horses can also spread ringworm to humans. People catch ringworm from touching the animals, or touching their bedding, grooming items, saddles, carpeting, etc. Swipe to advance 14 / 16 How Is Ringworm Diagnosed? Sometimes, the diagnosis of ringworm is obvious from its location and appearance. Otherwise, doctors can test skin scrapings for tinea fungus. Swipe to advance 15 / 16 How Is Ringworm Treated? Ringworm can be treated with antifungal creams containing clotrimazole (Cruex, Lotrimin), miconazole (Desenex, Monistat-Derm), ketoconazole (Nizoral), and terbinafine (Lamisil). In cases of severe or resistant infections on the scalp or nails, doctors may prescribe oral medicines such as terbinafine, itraconazole (Sporanox), griseofulvin, fluconazole (Diflucan), ciclopirox, or naftifine.

Swipe to advance (1) Copyright © Pulse Picture Library/CMP Images / Phototake -- All rights reserved. (2) Copyright © ISM / Phototake -- All rights reserved. (3) David Scharf / Science Faction / Getty Images (4) Copyright © ISM / Phototake -- All rights reserved. (5) Copyright 2007 Interactive Medical Media LLC (6) Credit: Dr. H.C. Robinson / Photo Researchers, Inc. (7) Copyright © ISM / Phototake -- All rights reserved. (8) Copyright 2007 Interactive Medical Media LLC (9) Copyright 2007 Interactive Medical Media LLC (10) Copyright 2007 Interactive Medical Media LLC (11) Credit: Mike Devlin / Photo Researchers, Inc. (12) David Madison / Photographer's Choice / Getty Images (13) Sami Sarkis / Photographer's Choice / Getty Images (14) Copyright 2007 Interactive Medical Media LLC (15) Brayden Knell / WebMD (16) Adam Gault / Digital Vision / Getty Images REFERENCES:

Question: What is the common name of the disease Tinea pedis?
Answer: Athlete's Foot