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Athletes FootAthlete's foot or Tinea pedis is a parasitic fungal infection of the epidermis of the foot. It is typically caused by a mould (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. Causes The body normally hosts a variety of saprotrophic microorganisms that rapidly cause infection. Athlete's foot is a layman's description of a skin fungal infection. It may be associated with several different fungi, including yeasts. The most common fungi causing tinea pedis are Trichophyton rubrum and T. mentagrophytes. Fungal infections of the skin are called dermatophytosis. Dermatophytes may be spread from other humans (anthropophilic), animals (zoophilic) or may come from the soil (geophilic). Anthropophillic dermatophytes are restricted to human hosts and produce a mild, chronic inflammation. Zoophilic organisms are found primarily in animals and cause marked inflammatory reactions in humans who have contact with infected cats, dogs, cattle, horses, birds, or other animals. Geophilic species are usually recovered from the soil but occasionally infect humans and animals. They cause a marked inflammatory reaction, which limits the spread of the infection and may lead to a spontaneous cure but may also leave scars. Infections or infestations occur when dermatophytes grow and multiply in the skin. Symptoms 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. 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. Diagnosis Diagnosis can be performed by a general practitioner or by a specialist (either a dermatologist or podiatrist). Although athlete's foot can usually be diagnosed by visual inspection of the skin, the diagnosis should always include direct microscopy of a potassium hydroxide preparation (known as a KOH test) at the start of treatment to rule out other possible causes, such as eczema or psoriasis. 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. A microbiological culture of skin scrapings can be used in diagnosis, but the process takes several weeks and can often give false negative results. Tinea infections are sometimes misdiagnosed as atopic dermatitis or allergic eczema, 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. Transmission Transmission from person to person Athlete's foot is caused by a parasitic fungus and is a communicable disease. It is typically transmitted in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms. It can also be transmitted by sharing footwear with an infected person, or less commonly, by sharing towels with an infected person. Transmission to other parts of the body The various parasitic fungi that cause can also cause skin infections on other areas of the body, most often under toenails (Onychomycosis) or on the groin (tinea cruris). 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. 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. By controlling the fungus growth in the household, transmission of the infection can be prevented.
Prevention measures in public places
Personal prevention measures
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. However, placebo-controlled trials of allylamines and azoles for athlete’s foot consistently produce much higher percentages of cure than placebo. 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 prevention. Keeping feet dry and practicing good hygiene is crucial to preventing re-infection. Severe or prolonged fungal skin infections may require treatment with oral anti-fungal medication. Conventional Topical Medications 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, 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.). 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 (e.g. naftin and lamisil). 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. Alternative treatments The use of essential oils which are fungicidal can be beneficial. Lavender essential oils combined with Myrrh essential oil or Tea Tree essential oil used on its own are the best. Other oils which can help are Cypress, Lemon and Tagetes. For children add a combination of 1 drop Lavender essential oil, 1 drop Tea Tree essential oil and 1 drop Tagetes essential oil to a bowl of warm water and soak the child’s feet twice a day. Alternatively put the essential oils into 10ml carrier oil and massage into the affected area. |
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