Tinea pedis is most often caused by Trichophyton rubrum. Typically, patients describe pruritic scaly soles, often with painful fissures between the toes. Vesicular or ulcerative lesions may also be present. The most characteristic type of infection is interdigital (Fig. 33-44). Erythema, maceration, and fissur-ing occur between the toes and are accompanied by intense pruritus. Patients may also have chronic hyperkeratotic tinea pedis, characterized by plantar erythema and hyperkerato-sis that may be completely asymptomatic or mildly pruritic. This is described as a moccasin distribution (Fig. 33-45). Inflammatory tinea pedis causes painful vesicles on the foot (see Fig. 33-1).
Tinea pedis is more common in men than in women and rarely occurs in children. Infection can occur through contact with infected scales on bath or pool floors, so wearing protective footwear in shared areas may help decrease the likelihood of infection. Occlusive footwear promotes infection by creating warm, humid, macerating environments; therefore patients should try to minimize foot moisture by limiting the use of occlusive footwear and frequently changing socks.
The treatment of tinea pedis involves application of an antifungal cream to the web spaces and other infected areas. Topical antifungal agents containing allylamines (naftifine, terbinafine, butenafine) or azoles (clotrimazole, miconazole, econazole) all work to treat tinea pedis. Allylamines cure slightly more infections than azoles but are more expensive. No differences in efficacy were found between individual allylamines or individual azoles (Crawford et al., 2000) Infrequently, systemic therapy is used for refractory infections. Twice-daily application of the allylamine terbinafine has resulted in a higher cure rate than twice-daily application of the imidazole clotrimazole (Lotrimin AF), and more rapidly.
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