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{{Infobox_Disease |
{{otheruses4|a medical condition|the American retail shoe store|The Athlete's Foot}}
{{Infobox Disease |
   Name          = Athlete's foot or tinea pedis |
   Name          = Athlete's foot or tinea pedis |
   Image          = athletes.jpg |
   Image          = athletes.jpg |
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{{SI}}
{{SI}}
{{EH}}
{{EH}}
'''Athlete's foot''' (tinea pedis) is a [[fungal infection]] of the skin that causes scaling, flaking, and itching of affected areas.  It is typically transmitted in moist areas where people walk barefoot, such as showers or bathhouses.  Although the condition typically affects the feet, it can spread to other areas of the body, including the [[groin]].  Athlete's foot can be prevented by good [[hygiene]], and is treated by a number of pharmaceutical and other treatments.
==Symptoms==
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.  Secondary bacterial infection can accompany the fungal infection, sometimes requiring a course of oral [[antibiotics]].<ref name="pmid12895184">{{cite journal |author=Gupta AK, Skinner AR, Cooper EA |title=Interdigital tinea pedis (dermatophytosis simplex and complex) and treatment with ciclopirox 0.77% gel |journal=Int. J. Dermatol. |volume=42 |issue=Suppl 1|pages=23–7 |year=2003 |pmid=12895184 |doi=10.1046/j.1365-4362.42.s1.1.x}}</ref><ref name=Gupta1999>{{cite journal  |last = Guttman |first = C |authorlink = |coauthors = |title=Secondary bacterial infection always
accompanies interdigital tinea pedis |journal =Dermatol Times |volume =4 |issue= |pages =S12 |year =2003 |url= |doi =10.1046/j.1365-4362.42.s1.1.x |id = |accessdate=  }}</ref>


'''Athlete's foot''' or '''Tinea pedis'''<ref name=tinea>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]]).</ref> is a [[parasitic]] [[fungus|fungal]] infection of the [[epidermis]] of the foot.  It is typically caused by a [[mold]]<ref name=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 [[yeast]]s. </ref> (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.<ref name=webmd_risks> [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-What-Increases-Your-Risk] Risk factors for athlete's foot, at [[WebMD]]</ref>  Tinea
The infection can be spread to other areas of the body, such as the [[groin]], and usually is called by a different name once it spreads, such as [[tinea corporis]] on the body or limbs and [[tinea cruris]] (jock itch or dhobi itch) for an infection of the groin. Tinea pedis most often manifests between the toes, with the space between the fourth and fifth digits most commonly afflicted.<ref name=" Hasan2004">{{cite journal |author=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal= Clinical and Molecular Allergy|volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |doi=10.1186/1476-7961-2-5 |url=http://www.clinicalmolecularallergy.com/content/2/1/5}}</ref><ref name="pmid12537173">{{cite journal |author=Hainer BL |title=Dermatophyte infections |journal=American family physician |volume=67 |issue=1 |pages=101–8 |year=2003 |pmid=12537173 |doi=}}</ref><ref name="pmid10607333">{{cite journal |author=Hirschmann JV, Raugi GJ |title=Pustular tinea pedis |journal=J. Am. Acad. Dermatol. |volume=42 |issue=1 Pt 1 |pages=132–3 |year=2000 |pmid=10607333 |doi=10.1016/S0190-9622(00)90022-7}}</ref>
pedis is estimated to be the second most common skin disease in the United States, after [[acne]].<ref name="pmid12046779">{{cite journal |author=Weinstein A, Berman B |title=Topical treatment of common superficial tinea infections |journal=American family physician |volume=65 |issue=10 |pages=2095–102 |year=2002 |pmid=12046779 |doi= |url=http://www.aafp.org/afp/20020515/2095.html}}</ref> Up to 15% of the U.S. population may have tinea pedis.<ref name="pmid12076488">{{cite journal |author=Bell-Syer SE, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I |title=Oral treatments for fungal infections of the skin of the foot |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD003584 |year=2002 |pmid=12076488 |doi=}}</ref>
 
==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 ''[[Trichophyton mentagrophytes|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. [[Infection]]s or [[infestation]]s  occur when [[dermatophyte]]s grow and multiply in the skin.
 
== Symptoms ==
[[Image:Intertrigo-1.jpg|thumb|left|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.  Secondary bacterial infection can accompany the fungal infection, sometimes requiring a course of oral [[antibiotics]].<ref name="pmid12895184">{{cite journal |author=Gupta AK, Skinner AR, Cooper EA |title=Interdigital tinea pedis (dermatophytosis simplex and complex) and treatment with ciclopirox 0.77% gel |journal=Int. J. Dermatol. |volume=42 |issue=Suppl 1|pages=23–7 |year=2003 |pmid=12895184 |doi=}}</ref><ref name=Gupta1999>{{cite journal  |last = Guttman |first = C |authorlink = |coauthors = |title=Secondary bacterial infection often accompanies interdigital tinea pedis |journal =Dermatol Times |volume =4 |issue= |pages =S12 |date =2003 |url= |doi =10.1046/j.1365-4362.42.s1.1.x |id = |accessdate=  }}</ref>
 
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 corporis]] on the body or limbs and [[tinea cruris]] (jock itch) for an infection of the groin).
 
Tinea pedis most often manifests between the toes, with the webspace between the fourth and fifth digits most commonly afflicted .<ref name=" Hasan2004">{{cite journal |author=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal= |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |doi=10.1186/1476-7961-2-5 |url=http://www.clinicalmolecularallergy.com/content/2/1/5}}</ref> <ref name="pmid12537173">{{cite journal |author=Hainer BL |title=Dermatophyte infections |journal=American family physician |volume=67 |issue=1 |pages=101–8 |year=2003 |pmid=12537173 |doi=}}</ref> <ref name="pmid10607333">{{cite journal |author=Hirschmann JV, Raugi GJ |title=Pustular tinea pedis |journal=J. Am. Acad. Dermatol. |volume=42 |issue=1 Pt 1 |pages=132–3 |year=2000 |pmid=10607333 |doi=}}</ref>


==Diagnosis==
==Diagnosis==
Diagnosis can be performed by a [[general practitioner]] or by a specialist (either a [[dermatologist]] or [[podiatrist]]).
Diagnosis can be performed by a [[pharmacist]], [[general practitioner]], and by specialists such as 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]].<ref name=Palacio2000>{{cite journal |last=del Palacio |first=Amalia |authorlink= | coauthors=Margarita Garau, Alba Gonzalez-Escalada and Mª Teresa Calvo |title=Trends in the treatment of dermatophytosis | journal=Biology of Dermatophytes and other Keratinophilic Fungi |volume= |issue= |pages=148-158 |date= |url=http://www.dermatophytes.reviberoammicol.com/p148158.pdf |format=PDF |doi= |id= |accessdate=2007-10-10}}</ref> 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.<ref name="Hasan2004"/>
Athlete's foot can usually be diagnosed by visual inspection of the skin, but where the diagnosis is in doubt direct [[microscopy]] of a potassium hydroxide preparation (known as a [[KOH test]]) may help rule out other possible causes, such as [[eczema]] or [[psoriasis]].<ref name=Palacio2000>{{cite journal |last=del Palacio |first=Amalia |authorlink= | coauthors=Margarita Garau, Alba Gonzalez-Escalada and Mª Teresa Calvo |title=Trends in the treatment of dermatophytosis | journal=Biology of Dermatophytes and other Keratinophilic Fungi |volume= |issue= |pages=148–158 |date= |url=http://www.dermatophytes.reviberoammicol.com/p148158.pdf |format=PDF |doi= |id= |accessdate=2007-10-10}}</ref> 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.<ref name="Hasan2004"/>


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 for [[histological]] examination.
 
Tinea infections are sometimes misdiagnosed as atopic [[dermatitis]] or allergic [[eczema]],<ref name="Hasan2004"/> underscoring the importance of a KOH preparation or microbiological culture being performed before treatment is initiated.
 
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 dermatophytes that cause this disease do not fluoresce under ultraviolet light <ref name="Hasan2004"/>. However, it can be useful for determining if the disease is due to a non-fungal source.


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 dermatophytes that cause this disease do not fluoresce under ultraviolet light.<ref name="Hasan2004"/> However, it can be useful for determining if the disease is due to a non-fungal afflictor.


== Transmission ==
== Transmission ==
===Transmission from person to person===
===Transmission from person to person===
Athlete's foot is caused by a parasitic fungus and is a [[communicable disease]].<ref name=webmd_causes> [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-Cause Causes of athlete's foot], at [[WebMD]]</ref> It is typically transmitted  in moist environments where people walk barefoot, such as [[shower]]s, [[bath house]]s, and [[locker room]]s. <ref name=mayoclinic>{{cite web |title= Athlete's foot |url=http://www.mayoclinic.com/health/athletes-foot/DS00317 |publisher=[[Mayo Clinic]] Health Center}}</ref><ref name=webmd_risks/><ref name=webmd_causes/>  It can also be transmitted by sharing [[footwear]] with an infected person, or less commonly, by sharing towels with an infected person.
Athlete's foot is caused by a parasitic fungus and is a [[communicable disease]].<ref name=webmd_causes> [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-Cause Causes of athlete's foot], at [[WebMD]]</ref> It is typically transmitted  in moist environments where people walk [[barefoot]], such as [[shower]]s, [[bath house]]s, and [[locker room]]s.<ref name=mayoclinic>{{cite web |title= Athlete's foot |url=http://www.mayoclinic.com/health/athletes-foot/DS00317 |publisher=[[Mayo Clinic]] Health Center}}</ref><ref name=webmd_risks> [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-What-Increases-Your-Risk] Risk factors for athlete's foot, at [[WebMD]]</ref><ref name=webmd_causes/>  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===
===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 [[toenail]]s ([[Onychomycosis]]) or on the groin ([[tinea cruris]]).
The various parasitic fungi that cause athlete's foot can also cause skin infections on other areas of the body, most often under [[toenail]]s ([[Onychomycosis]]) or on the groin ([[tinea cruris]]).


== Prevention ==
==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. 


The fungi that cause Athlete's foot can live on showers floors, wet towels, and footwear. Athlete's foot is caused by a fungus and can spread from person to person from shared contact with showers, towels, etc.  Hygiene therefore plays an important role in managing an Athlete's foot infection.  Since fungi thrive in moist environments, it is very important to keep feet and footwear as dry as possible.
{{howto|section}}
 
The practices given in this section do not only help prevent spread of the fungus, they can also help greatly in managing and curing athlete's foot in an individual by reducing or eliminating re-exposure to the fungus in one's home environment. 
 
The fungi that cause athlete's foot can live on shower floors, wet towels, and footwear. Athlete's foot is caused by a fungus and can spread from person to person from shared contact with showers, towels, etc.  Hygiene therefore plays an important role in managing an athlete's foot infection.  Since fungi thrive in moist environments, it is very important to keep feet and footwear as dry as possible.


===Prevention measures in the home===
===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.<ref name=household1>{{cite news |author=Robert Preidt
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.<ref name=household1>{{cite news |author=Robert Preidt
|title=Athlete's Foot, Toe Fungus a Family Affair |url=http://www.healthscout.com/news/68/535172/main.html |format=Reprint at USA Today |publisher=HealthDay News |date=[[September 29]], [[2006]] |accessdate=2007-10-10 |quote="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."}}</ref>  By controlling the fungus growth in the household, transmission of the infection can be prevented.   
|title=Athlete's Foot, Toe Fungus a Family Affair |url=http://www.healthscout.com/news/68/535172/main.html |format=Reprint at ''USA Today'' |publisher=''HealthDay News'' |date=[[September 29]], [[2006]] |accessdate=2007-10-10 |quote="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."}}</ref>  By controlling the fungus growth in the household, transmission of the infection can be prevented.   
   
   
====Bathroom hygiene====
====Bathroom hygiene====
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====Frequent laundering====
====Frequent laundering====
*Wash sheets, towels, socks, underwear, and bed clothes in hot water (at 60 °C / 140 °F) to kill the fungus.   
*Wash sheets, towels, socks, underwear, and bedclothes in hot water (at 60&nbsp;°C / 140&nbsp;°F) to kill the fungus.   
*Change towels and bed sheets at least once per week.
*Change towels and bed sheets at least once per week.


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*Wear shower shoes or sandals in locker rooms, public showers, and public baths.
*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.
*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.
*If you have experienced an infection previously, you may want to treat your feet and shoes with [[over-the-counter drugs]].


===Personal prevention measures===
===Personal prevention measures===
*Dry feet well after showering, paying particular attention to the web space between the toes.
*Dry feet well after showering, paying particular attention to the web space between the toes.
*Try to limit the amount that your feet sweat by wearing open-toed shoes or well-ventilated shoes, such as light-weight mesh running shoes.
*Try to limit the amount that your feet sweat by wearing open-toed shoes or well-ventilated shoes, such as lightweight mesh running shoes.
*Wear light-weight cotton socks to help reduce sweat.
*Wear lightweight cotton socks to help reduce [[sweat]].  These must be washed in hot water and/or bleached to avoid reinfection. New light weight, moisture wicking polyester socks, especially those with anti-microbial properties, may be a better choice.
*Use foot powder to help reduce sweat. Some footpowders also include an antifungal ingredient.
*Use foot powder to help reduce moisture and friction. Some foot powders also include an anti-fungal ingredient.
*Wear open-toed shoes or simply light-weight socks without shoes when at home.
*Wear open-toed shoes or simply light-weight socks without shoes when at home.
*Keep shoes dry by wearing a different pair each day.
*Keep shoes dry by wearing a different pair each day.
*Change socks and shoes after exercise.
*Change socks and shoes after exercise.
*Replace sole inserts in shoes/sneakers on a frequent basis
*Replace sole inserts in shoes/sneakers on a frequent basis.
*Replace old sneakers and exercise shoes.
*Replace old sneakers and exercise shoes.
*To prevent jock itch: When getting dressed, put on socks before underwear.<ref>[http://www.emedicine.com/derm/TOPIC471.HTM#section~Treatment eMedicine - Tinea Cruris : Article by Michael Wiederkehr<!-- Bot generated title -->]</ref>
*After any physical activity shower with a soap that has both an antibacterial and anti-fungal agent in it.


==Treatments==
==Treatments==
There are many conventional medications (over-the-counter and prescription) as well as alternative treatments for fungal skin infections, including athlete's foot. Important with any treatment plan is the practice of good hygiene. Several placebo controlled studies report that good foot hygiene alone can cure athlete's foot even without medication in 30-40% of the cases<ref>[http://www.aafp.org/afp/20010901/791.html Over-the-Counter Foot Remedies] (American Family Physician)</ref>. However, placebo-controlled trials of allylamines and azoles for athlete’s foot consistently produce much higher percentages of cure than placebo.<ref name="Crawford_2007">{{cite journal |author=Crawford F, Hollis S |title=Topical treatments for fungal infections of the skin and nails of the foot |journal=[[Cochrane Library|Cochrane Database of Systematic Reviews]] |year=2007 |date= 18 July |issue=3 |pages=Art. No.: CD001434 |doi=10.1002/14651858.CD001434.pub2 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001434/frame.html  |format=Review}}</ref>
There are many conventional medications (over-the-counter and prescription) as well as alternative treatments for fungal skin infections, including athlete's foot. Important with any treatment plan is the practice of good hygiene. Several placebo controlled studies report that good foot hygiene alone can cure athlete's foot even without medication in 30-40% of the cases.<ref>[http://www.aafp.org/afp/20010901/791.html Over-the-Counter Foot Remedies] (American Family Physician)</ref>  However, placebo-controlled trials of [[allylamine]]s and [[azole]]s for athlete’s foot consistently produce much higher percentages of cure than placebo.<ref name="Crawford_2007">{{cite journal |author=Crawford F, Hollis S |title=Topical treatments for fungal infections of the skin and nails of the foot |journal=[[Cochrane Library|Cochrane Database of Systematic Reviews]] |date= 18 July 2007 |issue=3 |pages=Art. No.: CD001434 |doi=10.1002/14651858.CD001434.pub2 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001434/frame.html  |format=Review}}</ref>  


===Conventional treatments===
===Conventional treatments===
Conventional treatment typically involves daily or twice daily application of a topical medication in conjunction with hygiene measures outlines in the above section on [[Athlete's foot#prevention|prevention]].  Keeping feet dry and practicing good hygiene is crucial to preventing reinfection. Severe or prolonged fungal skin infections may require treatment with oral anti-fungal medication.
Conventional treatment typically involves daily or twice daily application of a topical medication in conjunction with hygiene measures outlined in the above section on [[Athlete's foot#prevention|prevention]].  Keeping feet dry and practicing good hygiene is crucial to preventing reinfection. Severe or prolonged fungal skin infections may require treatment with oral anti-fungal medication. Apply zinc oxide based diaper rash ointment. To prevent sweaty or wet feet that are breeding grounds for athlete's foot, apply [[talcum powder]] (baby powder) to absorb moisture that kills off the infection.


====Conventional Topical Medications====
====Topical medications====
{{main|Antifungal drug}}
{{main|Antifungal drug}}


The fungal infection is often treated with topical [[antifungal drug|antifungal]] agents, which can take the form of a spray, powder, cream, or gel.  The most common ingredients in [[over-the-counter]] products are [[Miconazole nitrate]] (2% typical concentration in the United States) and [[Tolnaftate]] (1% typ. in the U.S.). [[Terbinafine]], marketed as Lamisil is another over-the-counter drug.   There exists a large number of prescription antifungal drugs, from several different drug families. These include [[ketaconazole]], [[itraconazole]], [[naftifine]], [[nystatin]], [[caspofungin]]. Studies show that Allylamines ([[Terbinafine]], [[Amorolfine]], [[Naftifine]], [[Butenafine]]) cure slightly more infections than azoles ([[Miconazole]], [[ketaconazole]], [[Clotrimazole]], [[itraconazole]], [[sertaconazole]], etc.).<ref name="Crawford_2007"/>
The fungal infection is often treated with topical [[antifungal drug|antifungal]] agents, which can take the form of a spray, powder, cream, or gel.  The most common ingredients in [[Over-the-counter drug|over-the-counter]] products are [[miconazole nitrate]] (2% typical concentration in the United States) and [[tolnaftate]] (1% typ. in the U.S.). [[Terbinafine]], is another over-the-counter drug. There exists a large number of prescription antifungal drugs, from several different drug families. These include [[ketaconazole]], [[itraconazole]], [[naftifine]], [[nystatin]], [[caspofungin]]. One study showed that allylamines ([[terbinafine]], [[Amorolfine]], [[naftifine]], [[butenafine]]) cure slightly more infections than azoles ([[Miconazole]], [[ketaconazole]], [[clotrimazole]], [[itraconazole]], [[sertaconazole]], etc.).<ref name="Crawford_2007"/> [[Undecylenic acid]] (a [[castor oil]] derivative) is a known fungicide that can be used for fungal skin infections such as athlete's foot. [[Whitfield's Ointment]] (benzoic and salicylic acid) is an older treatment that still sees occasional use.


Topical agents only clear the infection about 30% of the time and provide mycologic cures (absence of organisms) less than 15% of the time.{{Fact|date=September 2007}} The time line for cure may be long, often 45 days or longer. The recommended course of treatment is to ''continue to use the topical treatment for four weeks after the symptoms have subsided to ensure that the fungus has been completely eliminated''. However, because the itching associated with the infection subsides quickly, patients may not complete the courses of therapy prescribed.  
Some topical applications such as [[carbol fuchsin]] (also known in the U.S. as Castellani's paint), often used for [[intertrigo]], work well but in small selected areas. This red dye, used in this treatment like many other [[staining (biology)|vital stains]], is both [[Fungicide|fungicidal]] and [[Bacteriocide|bacteriocidal]]; however, because of the staining it is cosmetically undesirable. For many years [[gentian violet]] was also used for bacterial and fungal infections between fingers or toes.  


Anti-itch creams are ''not'' recommended as they will alleviate the symptoms but will exacerbate the fungus; this is due to the fact that anti-itch creams typically enhance the moisture content of the skin and encourage fungal growth.  For the same reason, some drug manufacturers are using a gel instead of a cream for application of topical drugs (e.g. [[naftin]] and [[lamisil]]).  [[Novartis]], maker of lamisil claims that gel penetrates the skin more quickly than cream.
The time line for cure may be long, often 45 days or longer. The recommended course of treatment is to ''continue to use the topical treatment for four weeks after the symptoms have subsided'' to ensure that the fungus has been completely eliminated. However, because the itching associated with the infection subsides quickly, patients may not complete the courses of therapy prescribed.  


Some topical applications such as [[castellani's Paint]], often used for [[intertrigo]], work well but in small selected areas. [[Carbol fuchsin]] red dye used in this treatment like many other [[staining (biology)|vital stains]] is both [[Fungicide|fungicidal]] and [[Bacteriocide|bacteriocidal]]; however, because of the staining are cosmetically undesirable. For many years [[gentian violet]] was also used for bacterial and fungal infections between fingers or toes.  
Anti-itch creams are ''not'' recommended as they will alleviate the symptoms but will exacerbate the fungus; this is due to the fact that anti-itch creams typically enhance the moisture content of the skin and encourage fungal growth. For the same reason, some drug manufacturers are using a gel instead of a cream for application of topical drugs (for example, [[naftin]] and Lamisil). [[Novartis]], maker of Lamisil, claims that a gel penetrates the skin more quickly than cream.
 
[[Undecylenic acid]] (Castor oil derivative) is known fungicide that can be used for fungal skin infections such as athlete's foot.


If the fungal invader is not a dermatophyte but a yeast, other medications such as [[fluconazole]] may be used. Typically fluconazole 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) of the toes 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.
If the fungal invader is not a dermatophyte but a yeast, other medications such as [[fluconazole]] may be used. Typically fluconazole 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) of the toes 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.


====Oral Medications====
====Oral medications====
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.{{fact|date=29 September 2007}}
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.{{Fact|date=September 2007}}


For severe cases, the current preferred oral agent in the UK,<ref>{{cite web |author=[[National Library for Health]] |title=What is the best treatment for tinea pedis? |url=http://www.clinicalanswers.nhs.uk/index.cfm?question=6098 |date= 06/Sep/07 |publisher=UK [[National Health Service]] |accessdate=2007-09-29}}</ref> is the more effective [[terbinafine]].<ref name="Bell-Syer_2002">{{cite journal |author=Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I. |title=Oral treatments for fungal infections of the skin of the foot. |journal=[[Cochrane Library|Cochrane Database of Systematic Reviews]] |year=2002 |month=22 April |volume=2 |pages=Art. No.: CD003584. |doi=10.1002/14651858.CD003584 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003584/frame.html |format=Review}}</ref> Other prescription oral antifungals include [[itraconazole]] and [[fluconazole]]<ref name="pmid12895184"/>.
For severe cases, the current preferred oral agent in the UK,<ref>{{cite web |author=[[National Health Service (England)|National Library for Health]] |title=What is the best treatment for tinea pedis? |url=http://www.clinicalanswers.nhs.uk/index.cfm?question=6098 |date= 06/September/07 |publisher=UK [[National Health Service (England)|National Health [[Media:Service]]|accessdate=2007]]-09-29}}</ref> is the more effective [[terbinafine]].<ref name="Bell-Syer_2002">{{cite journal |author=Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I. |title=Oral treatments for fungal infections of the skin of the foot |journal=[[Cochrane Library|Cochrane Database of Systematic Reviews]] |year=2002 |month=22 April |volume=2 |pages=Art. No.: CD003584. |doi=10.1002/14651858.CD003584 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003584/frame.html |format=Review}}</ref> Other prescription oral antifungals include [[itraconazole]] and [[fluconazole]].<ref name="pmid12895184"/>


===Alternative treatments===
===Alternative treatments===
====Topical oils====
====Topical oils====
Symptomatic relief from itching may be achieved after topical application of [[tea tree oil]] or [[crocodile oil]], probably due to its involvement in the [[histamine]] response,<ref name="pmid12452873">{{cite journal |author=Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH |title=Tea tree oil reduces histamine-induced skin inflammation |journal=Br. J. Dermatol. |volume=147 |issue=6 |pages=1212–7 |year=2002 |pmid=12452873 |doi=}}</ref> however the efficacy of Tea tree oil in the treatment of athlete's foot (achieving mycological cure) is questionable.<ref name="pmid11563570">{{cite journal |author=Bedinghaus JM, Niedfeldt MW |title=Over-the-counter foot remedies |journal=American family physician |volume=64 |issue=5 |pages=791–6 |year=2001 |pmid=11563570 |doi= |url=http://www.aafp.org/afp/20010901/791.html}}</ref><ref name="pmid1303075">{{cite journal |author=Tong MM, Altman PM, Barnetson RS |title=Tea tree oil in the treatment of tinea pedis |journal=Australas. J. Dermatol. |volume=33 |issue=3 |pages=145–9 |year=1992 |pmid=1303075 |doi=}}</ref>
Symptomatic relief from itching may be achieved after topical application of [[tea tree oil]], probably due to its involvement in the [[histamine]] response;<ref name="pmid12452873">{{cite journal |author=Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH |title=Tea tree oil reduces histamine-induced skin inflammation |journal=Br. J. Dermatol. |volume=147 |issue=6 |pages=1212–7 |year=2002 |pmid=12452873 |doi=10.1046/j.1365-2133.2002.05034.x}}</ref> however, the efficacy of tea tree oil in the treatment of athlete's foot (achieving mycological cure) is questionable.<ref name="pmid11563570">{{cite journal |author=Bedinghaus JM, Niedfeldt MW |title=Over-the-counter foot remedies |journal=American family physician |volume=64 |issue=5 |pages=791–6 |year=2001 |pmid=11563570 |doi= |url=http://www.aafp.org/afp/20010901/791.html}}</ref><ref name="pmid1303075">{{cite journal |author=Tong MM, Altman PM, Barnetson RS |title=Tea tree oil in the treatment of tinea pedis |journal=Australas. J. Dermatol. |volume=33 |issue=3 |pages=145–9 |year=1992 |pmid=1303075 |doi=10.1111/j.1440-0960.1992.tb00103.x}}</ref>


====Onion extract====
====Onion extract====
A study of the effect of 3% (v/v) aqueous onion extract was shown to be effective in laboratory conditions against Trichophyton mentagrophytes and T. rubrum.<ref name=onionextract>{{cite web |author=Shams M |title=The effect of onion extract on ultrastructure of Trichophyton mentagrophytes and T. rubrum -- Abstract number: 902_p517 |work=14th European Congress of Clinical Microbiology and Infectious Diseases Prague / Czech Republic |date=May 1–4, 2004 |publisher=European Society of clinical Microbiology and Infectious Diseases |url=http://www.blackwellpublishing.com/eccmid14/abstract.asp?id=14160 |accessdate=2007-09-29}}</ref>
A study of the effect of 3% (v/v) aqueous onion extract was shown to be very effective in laboratory conditions against ''Trichophyton mentagrophytes'' and ''T. rubrum''.<ref name=onionextract>{{cite web |author=Shams M |title=The effect of onion extract on ultrastructure of Trichophyton mentagrophytes and T. rubrum -- Abstract number: 902_p517 |work=14th European Congress of Clinical Microbiology and Infectious Diseases Prague / Czech Republic |date=May 1–4, 2004 |publisher=European Society of clinical Microbiology and Infectious Diseases |url=http://www.blackwellpublishing.com/eccmid14/abstract.asp?id=14160 |accessdate=2007-09-29}} and it is very strong</ref>


====Household bleach (sodium hypochlorite)====
====Garlic extract====
The use of household [[bleach]] as a direct topical application or soak for tinea pedis is not recommended, as it is a well documented irritant (clearly labelled in the United Kingdom as "Harmful" by [[COSHH]]).  It is used ''diluted'' as an '''environmental''' decontaminatant to prevent the spread of detmatophytes between animals, and from animals to humans.<ref>{{cite journal |last=Burrows |first=M |authorlink= |coauthors= |year= |month= |title=Treating Ringworm in the cat |journal=The Veternarian |volume= |issue= |pages= |id= |url=http://www.theveterinarian.com.au/clinicalreview/article294.asp  |accessdate= 2007-10-10 |quote= }}</ref>
[[Ajoene]], a compound found in garlic, is sometimes used to treat athlete's foot.<ref>{{cite journal | author=Eliades Ledezma, Katiuska Marcano, Alicia Jorquera, Leonardo De Sousa, Maria Padilla, Mireya Pulgar, Rafael Apitz-Castro | title=Efficacy of ajoene in the treatment of tinea pedis: A double-blind and comparative study with terbinafine| journal=Journal of the American Academy of Dermatology | date=2000-11 | volume=43 | issue=5 | pages=829–832 | url=http://download.journals.elsevierhealth.com/pdfs/journals/0190-9622/PIIS0190962200343675.pdf |format=PDF| doi=10.1067/mjd.2000.107243 | format={{Dead link|date=June 2008}} &ndash; <sup>[http://scholar.google.co.uk/scholar?hl=en&lr=&q=intitle%3AEfficacy+of+ajoene+in+the+treatment+of+tinea+pedis%3A+A+double-blind+and+comparative+study+with+terbinafine&as_publication=Journal+of+the+American+Academy+of+Dermatology&as_ylo=&as_yhi=&btnG=Search Scholar search]</sup>}}</ref>


====Rubbing alcohol and hydrogen peroxide====
====Rubbing alcohol, hydrogen peroxide and vinegar====
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.
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.{{Fact|date=January 2008}}  In addition, soaking the feet in a bath of 70% rubbing alcohol will help dry the skin out, and likewise kill the invading fungus.{{Fact|date=April 2008}}  The alcohol is not, however, effective against spores. [[Vinegar]] in some cases has killed the fungus and is effective against spores.
 
====Boric acid====
[[Boric acid]] application in the socks is used to prevent athlete's foot when recurrent infections occurs, but is not used to treat it.


====Hair dryer====
====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.
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, or to dry feet which have become slightly moist in between showers or baths.{{Fact|date=January 2008}}


====Baking soda====
Rubbing feet with a baking soda paste and/or sprinkling baking soda in shoes is thought to help by changing pH.<ref>[http://www.mothernature.com/Library/Bookshelf/Books/47/7.cfm The Doctors Book of Home Remedies Athletes Foot<!-- Bot generated title -->]</ref>


====Household bleach (not recommended)====
The use of household [[bleach]] as a direct topical application or soak for tinea pedis is not recommended, as it is a well documented irritant (clearly labelled in the United Kingdom as "Harmful" by [[COSHH]]){{Fact|date=December 2008}}.  It is used ''diluted'' as an '''environmental''' decontaminatant to prevent the spread of dermatophytes between animals, and from animals to humans.


==Origin of the term "athlete's foot"==
====Epsom salts====
[[W. F. Young]], Inc. claims that the term "athlete's foot" was originated during an advertising campaign for [[Absorbine Jr.]] during the [[1930s]].<ref name=absorbinejr> The [http://www.absorbine.com/absorbinejr/about Story of W. F. Young, Inc. and Absorbine] at the Absorbine website.</ref> 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.
Some podiatrists recommend soaking the feet in a solution of [[magnesium sulfate|Epsom salts]] in warm water.


==Footnotes==
=====Urinating=====
{{reflist|2}}
Members of the US Military have used the method of urinating on the infected foot in the shower to get rid of the infection. It has proven non-effective.{{Fact|date=March 2009}}
 
==Etymology==
The [[Oxford English Dictionary]] documents written usage of the term in 1928 ('''1928''' ''Lit. Digest'' [[22 December]]. 16/1), which seems to undercut the claim by W. F. Young, Inc. that the term "athlete's foot" was originated, rather than simply popularized, as part of an advertising campaign for [[Absorbine Jr.]] during the 1930s.<ref name=absorbinejr> The [http://www.absorbine.com/absorbinejr/about Story of W. F. Young, Inc. and Absorbine] at the Absorbine website.</ref>


==See also==
==See also==
*[[Tinea]]  
* [[Antifungal drug]]s
*[[Tinea cruris]] "Jock Itch"
* [[Boric acid]] - as treatment
*[[Tinea capitis]] Fungal infection of the scalp
* [[Ringworm]]
*[[Onychomycosis]] Fungal infection of the finger nails and toenails
* [[Tinea]]
*[[Tinea unguium]] The most common type of fungal infection of the finger nails and toenails
 
*[[Dermatophyte]] The parasitic fungi that cause tinea
==Footnotes==
*[[Ringworm]]
{{Reflist|2}}
*[[Antifungal drug]]s


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


===General medical information===
* [[American Podiatric Medical Association|APMA]] [http://www.apma.org/s_apma/doc.asp?CID=371&DID=9386 Athlete's Foot Article]
* [[DermNet NZ]] — [[New Zealand Dermatological Society]] [http://www.dermnetnz.org/fungal/athletes-foot.html Athlete's Foot Article]
* [[Doctor Fungus]] [http://www.doctorfungus.org/mycoses/human/other/TineaCorporis_Cruris_Pedis.htm#Pedis  Athlete's Foot Article]
* [[eMedicine]] [http://www.emedicine.com/derm/byname/eumycetoma-(fungal-mycetoma).htm Eumycetoma (Fungal Mycetoma) Article Excerpt]
* [[eMedicine|eMedicine Health]] [http://www.emedicinehealth.com/articles/16005-1.asp Athlete's Foot Article]
* [[Harvard Medical School]] [http://www.health.harvard.edu/special_health_reports/Foot_Care_Basics.htm Foot Care Basics]. Available for a small fee.
* [[Healthline]] [http://www.healthline.com/adamcontent/athletes-foot Athlete's Foot Article]
* [[iVillage]] [http://health.ivillage.com/infectious/inffungus/topics/0,,4v99,00.html Fungal Infections Article]
* [[Mayo Clinic]] [http://www.mayoclinic.com/health/athletes-foot/DS00317 Athlete's Foot Article]
* [[MedicineNet]] [http://www.medicinenet.com/athletes_foot/article.htm Athlete's Foot Article]
* [[MedlinePlus]] [http://www.nlm.nih.gov/medlineplus/athletesfoot.html Athlete's Foot Article]
* [[MedlinePlus]] [http://www.nlm.nih.gov/medlineplus/athletesfoot.html Athlete's Foot Article]
* [[Merck & Co.|Merck]] [http://www.merck.com/mmhe/sec18/ch212/ch212b.html?qt=athlete's%20foot&alt=sh Ringworm and Athlete's Foot Article]
* [[WebMD]] [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-Topic-Overview Athlete's Foot Article]
* [[MSN]] Health and Fitness [http://health.msn.com/centers/skincare/articlepage.aspx?cp-documentid=100069342  Athlete's Foot Article]
* [[Stop Athlete's Foot]] - [http://www.stopathletesfoot.com Athlete's Foot Articles]
* [[WebMD]] [http://www.webmd.com/skin-problems-and-treatments/tc/Athletes-Foot-Topic-Overview Athlete's Foot Article]  


===Photos===
{{Mycoses}}
* [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=179 Photos of Tinea Pedis] at [[DermAtlas]]
* [http://www.globalskinatlas.com/index.cfm Global Skin Atlas]. Type "tinea pedis" in search engine.


===Organizations===
{{Diseases of the skin and appendages by morphology}}
* [http://www.aad.org/default.htm American Academy of Dermatology]
* [http://www.apma.org American Podiatric Medical Association]
* [http://www.skincell.org/ 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.''
* [http://www.feetforlife.org Society of Chiropodists and Podiatrists]
 
{{Mycoses}}
{{SIB}}


[[Category:Infectious skin diseases]]
[[Category:Infectious skin diseases]]
[[Category:Podiatry]]
[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Foot diseases]]
[[Category:Foot diseases]]


 
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Revision as of 15:47, 30 March 2009

Template:Otheruses4

Athlete's foot or tinea pedis
Pale, flaky & split skin of athlete's foot in a toe web space
ICD-10 B35.3
ICD-9 110.4
DiseasesDB 13122
MedlinePlus 000875
eMedicine derm/470 

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Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch. Athlete's foot (tinea pedis) is a fungal infection of the skin that causes scaling, flaking, and itching of affected areas. It is typically transmitted in moist areas where people walk barefoot, such as showers or bathhouses. Although the condition typically affects the feet, it can spread to other areas of the body, including the groin. Athlete's foot can be prevented by good hygiene, and is treated by a number of pharmaceutical and other treatments.

Symptoms

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. Secondary bacterial infection can accompany the fungal infection, sometimes requiring a course of oral antibiotics.[1][2]

The infection can be spread to other areas of the body, such as the groin, and usually is called by a different name once it spreads, such as tinea corporis on the body or limbs and tinea cruris (jock itch or dhobi itch) for an infection of the groin. Tinea pedis most often manifests between the toes, with the space between the fourth and fifth digits most commonly afflicted.[3][4][5]

Diagnosis

Diagnosis can be performed by a pharmacist, general practitioner, and by specialists such as a dermatologist or podiatrist.

Athlete's foot can usually be diagnosed by visual inspection of the skin, but where the diagnosis is in doubt direct microscopy of a potassium hydroxide preparation (known as a KOH test) may help rule out other possible causes, such as eczema or psoriasis.[6] 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.[3]

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 for histological examination.

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 dermatophytes that cause this disease do not fluoresce under ultraviolet light.[3] However, it can be useful for determining if the disease is due to a non-fungal afflictor.

Transmission

Transmission from person to person

Athlete's foot is caused by a parasitic fungus and is a communicable disease.[7] It is typically transmitted in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms.[8][9][7] 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 (tinea cruris).

Prevention

Template:Howto

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

The fungi that cause athlete's foot can live on shower floors, wet towels, and footwear. Athlete's foot is caused by a fungus and can spread from person to person from shared contact with showers, towels, etc. Hygiene therefore plays an important role in managing an athlete's foot infection. Since fungi thrive in moist environments, it is very important to keep feet and footwear as dry as possible.

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.[10] By controlling the fungus growth in the household, transmission of the infection can be prevented.

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 bedclothes 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.
  • Use a separate towel for drying infected skin areas.

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 drugs.

Personal prevention measures

  • Dry feet well after showering, paying particular attention to the web space between the toes.
  • Try to limit the amount that your feet sweat by wearing open-toed shoes or well-ventilated shoes, such as lightweight mesh running shoes.
  • Wear lightweight cotton socks to help reduce sweat. These must be washed in hot water and/or bleached to avoid reinfection. New light weight, moisture wicking polyester socks, especially those with anti-microbial properties, may be a better choice.
  • Use foot powder to help reduce moisture and friction. Some foot powders also include an anti-fungal ingredient.
  • Wear open-toed shoes or simply light-weight socks without shoes when at home.
  • Keep shoes dry by wearing a different pair each day.
  • Change socks and shoes after exercise.
  • Replace sole inserts in shoes/sneakers on a frequent basis.
  • Replace old sneakers and exercise shoes.
  • To prevent jock itch: When getting dressed, put on socks before underwear.[11]
  • After any physical activity shower with a soap that has both an antibacterial and anti-fungal agent in it.

Treatments

There are many conventional medications (over-the-counter and prescription) as well as alternative treatments for fungal skin infections, including athlete's foot. Important with any treatment plan is the practice of good hygiene. Several placebo controlled studies report that good foot hygiene alone can cure athlete's foot even without medication in 30-40% of the cases.[12] However, placebo-controlled trials of allylamines and azoles for athlete’s foot consistently produce much higher percentages of cure than placebo.[13]

Conventional treatments

Conventional treatment typically involves daily or twice daily application of a topical medication in conjunction with hygiene measures outlined in the above section on prevention. Keeping feet dry and practicing good hygiene is crucial to preventing reinfection. Severe or prolonged fungal skin infections may require treatment with oral anti-fungal medication. Apply zinc oxide based diaper rash ointment. To prevent sweaty or wet feet that are breeding grounds for athlete's foot, apply talcum powder (baby powder) to absorb moisture that kills off the infection.

Topical medications

Main article: Antifungal drug

The fungal infection is often treated with topical antifungal agents, which can take the form of a spray, powder, cream, or gel. The most common ingredients in over-the-counter products are miconazole nitrate (2% typical concentration in the United States) and tolnaftate (1% typ. in the U.S.). Terbinafine, is another over-the-counter drug. There exists a large number of prescription antifungal drugs, from several different drug families. These include ketaconazole, itraconazole, naftifine, nystatin, caspofungin. One study showed that allylamines (terbinafine, Amorolfine, naftifine, butenafine) cure slightly more infections than azoles (Miconazole, ketaconazole, clotrimazole, itraconazole, sertaconazole, etc.).[13] Undecylenic acid (a castor oil derivative) is a known fungicide that can be used for fungal skin infections such as athlete's foot. Whitfield's Ointment (benzoic and salicylic acid) is an older treatment that still sees occasional use.

Some topical applications such as carbol fuchsin (also known in the U.S. as Castellani's paint), often used for intertrigo, work well but in small selected areas. This red dye, used in this treatment like many other vital stains, is both fungicidal and bacteriocidal; however, because of the staining it is cosmetically undesirable. For many years gentian violet was also used for bacterial and fungal infections between fingers or toes.

The time line for cure may be long, often 45 days or longer. The recommended course of treatment is to continue to use the topical treatment for four weeks after the symptoms have subsided to ensure that the fungus has been completely eliminated. However, because the itching associated with the infection subsides quickly, patients may not complete the courses of therapy prescribed.

Anti-itch creams are not recommended as they will alleviate the symptoms but will exacerbate the fungus; this is due to the fact that anti-itch creams typically enhance the moisture content of the skin and encourage fungal growth. For the same reason, some drug manufacturers are using a gel instead of a cream for application of topical drugs (for example, naftin and Lamisil). Novartis, maker of Lamisil, claims that a gel penetrates the skin more quickly than cream.

If the fungal invader is not a dermatophyte but a yeast, other medications such as fluconazole may be used. Typically fluconazole 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) of the toes 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.

Oral medications

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.[citation needed]

For severe cases, the current preferred oral agent in the UK,[14] is the more effective terbinafine.[15] Other prescription oral antifungals include itraconazole and fluconazole.[1]

Alternative treatments

Topical oils

Symptomatic relief from itching may be achieved after topical application of tea tree oil, probably due to its involvement in the histamine response;[16] however, the efficacy of tea tree oil in the treatment of athlete's foot (achieving mycological cure) is questionable.[17][18]

Onion extract

A study of the effect of 3% (v/v) aqueous onion extract was shown to be very effective in laboratory conditions against Trichophyton mentagrophytes and T. rubrum.[19]

Garlic extract

Ajoene, a compound found in garlic, is sometimes used to treat athlete's foot.[20]

Rubbing alcohol, hydrogen peroxide and vinegar

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.[citation needed] In addition, soaking the feet in a bath of 70% rubbing alcohol will help dry the skin out, and likewise kill the invading fungus.[citation needed] The alcohol is not, however, effective against spores. Vinegar in some cases has killed the fungus and is effective against spores.

Boric acid

Boric acid application in the socks is used to prevent athlete's foot when recurrent infections occurs, but is not used to treat it.

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, or to dry feet which have become slightly moist in between showers or baths.[citation needed]

Baking soda

Rubbing feet with a baking soda paste and/or sprinkling baking soda in shoes is thought to help by changing pH.[21]

Household bleach (not recommended)

The use of household bleach as a direct topical application or soak for tinea pedis is not recommended, as it is a well documented irritant (clearly labelled in the United Kingdom as "Harmful" by COSHH)[citation needed]. It is used diluted as an environmental decontaminatant to prevent the spread of dermatophytes between animals, and from animals to humans.

Epsom salts

Some podiatrists recommend soaking the feet in a solution of Epsom salts in warm water.

Urinating

Members of the US Military have used the method of urinating on the infected foot in the shower to get rid of the infection. It has proven non-effective.[citation needed]

Etymology

The Oxford English Dictionary documents written usage of the term in 1928 (1928 Lit. Digest 22 December. 16/1), which seems to undercut the claim by W. F. Young, Inc. that the term "athlete's foot" was originated, rather than simply popularized, as part of an advertising campaign for Absorbine Jr. during the 1930s.[22]

See also

Footnotes

  1. ↑ 1.0 1.1 Gupta AK, Skinner AR, Cooper EA (2003). "Interdigital tinea pedis (dermatophytosis simplex and complex) and treatment with ciclopirox 0.77% gel". Int. J. Dermatol. 42 (Suppl 1): 23–7. doi:10.1046/j.1365-4362.42.s1.1.x. PMID 12895184.
  2. ↑ Guttman, C (2003). "Secondary bacterial infection always accompanies interdigital tinea pedis". Dermatol Times. 4: S12. doi:10.1046/j.1365-4362.42.s1.1.x. line feed character in |title= at position 37 (help)
  3. ↑ 3.0 3.1 3.2 Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G (2004). "Dermatology for the practicing allergist: Tinea pedis and its complications". Clinical and Molecular Allergy. 2 (1): 5. doi:10.1186/1476-7961-2-5. PMID 15050029.
  4. ↑ Hainer BL (2003). "Dermatophyte infections". American family physician. 67 (1): 101–8. PMID 12537173.
  5. ↑ Hirschmann JV, Raugi GJ (2000). "Pustular tinea pedis". J. Am. Acad. Dermatol. 42 (1 Pt 1): 132–3. doi:10.1016/S0190-9622(00)90022-7. PMID 10607333.
  6. ↑ del Palacio, Amalia. "Trends in the treatment of dermatophytosis" (PDF). Biology of Dermatophytes and other Keratinophilic Fungi: 148–158. Retrieved 2007-10-10. Unknown parameter |coauthors= ignored (help)
  7. ↑ 7.0 7.1 Causes of athlete's foot, at WebMD
  8. ↑ "Athlete's foot". Mayo Clinic Health Center.
  9. ↑ [1] Risk factors for athlete's foot, at WebMD
  10. ↑ Robert Preidt (September 29, 2006). "Athlete's Foot, Toe Fungus a Family Affair" (Reprint at USA Today). HealthDay News. Retrieved 2007-10-10. 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. Check date values in: |date= (help)
  11. ↑ eMedicine - Tinea Cruris : Article by Michael Wiederkehr
  12. ↑ Over-the-Counter Foot Remedies (American Family Physician)
  13. ↑ 13.0 13.1 Crawford F, Hollis S (18 July 2007). "Topical treatments for fungal infections of the skin and nails of the foot" (Review). Cochrane Database of Systematic Reviews (3): Art. No.: CD001434. doi:10.1002/14651858.CD001434.pub2.
  14. ↑ National Library for Health (06/September/07). "What is the best treatment for tinea pedis?". UK [[National Health Service (England)|National Health Media:Service|accessdate=2007]]-09-29. Check date values in: |date= (help)
  15. ↑ Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I. (2002). "Oral treatments for fungal infections of the skin of the foot" (Review). Cochrane Database of Systematic Reviews. 2: Art. No.: CD003584. doi:10.1002/14651858.CD003584. Unknown parameter |month= ignored (help)
  16. ↑ Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH (2002). "Tea tree oil reduces histamine-induced skin inflammation". Br. J. Dermatol. 147 (6): 1212–7. doi:10.1046/j.1365-2133.2002.05034.x. PMID 12452873.
  17. ↑ Bedinghaus JM, Niedfeldt MW (2001). "Over-the-counter foot remedies". American family physician. 64 (5): 791–6. PMID 11563570.
  18. ↑ Tong MM, Altman PM, Barnetson RS (1992). "Tea tree oil in the treatment of tinea pedis". Australas. J. Dermatol. 33 (3): 145–9. doi:10.1111/j.1440-0960.1992.tb00103.x. PMID 1303075.
  19. ↑ Shams M (May 1–4, 2004). "The effect of onion extract on ultrastructure of Trichophyton mentagrophytes and T. rubrum -- Abstract number: 902_p517". 14th European Congress of Clinical Microbiology and Infectious Diseases Prague / Czech Republic. European Society of clinical Microbiology and Infectious Diseases. Retrieved 2007-09-29. and it is very strong
  20. ↑ Eliades Ledezma, Katiuska Marcano, Alicia Jorquera, Leonardo De Sousa, Maria Padilla, Mireya Pulgar, Rafael Apitz-Castro (2000-11). "Efficacy of ajoene in the treatment of tinea pedis: A double-blind and comparative study with terbinafine" ([dead link] – Scholar search). Journal of the American Academy of Dermatology. 43 (5): 829–832. doi:10.1067/mjd.2000.107243. Check date values in: |date= (help)
  21. ↑ The Doctors Book of Home Remedies Athletes Foot
  22. ↑ The Story of W. F. Young, Inc. and Absorbine at the Absorbine website.

External links

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