Abstract
Tinea pedis is a chronic fungal infection of the feet, very often observed in patients who are immuno-suppressed or have diabetes mellitus. The practicing allergist may be called upon to treat this disease for various reasons. Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease. Patients with recurrent cellulitis may be referred to the allergist/immunologist for an immune evaluation and discovered to have tinea pedis as a predisposing factor. From a molecular standpoint, superficial fungal infections may induce a type2 T helper cell response (Th2) that can aggravate atopy. Th2 cytokines may induce eosinophil recruitment and immunoglobulin E (IgE) class switching by B cells, thereby leading to exacerbation of atopic conditions. Three groups of fungal pathogens, referred to as dermatophytes, have been shown to cause tinea pedis: Trychophyton sp, Epidermophyton sp, and Microsporum sp. The disease manifests as a pruritic, erythematous, scaly eruption on the foot and depending on its location, three variants have been described: interdigital type, moccasin type, and vesiculobullous type. Tinea pedis may be associated with recurrent cellulitis, as the fungal pathogens provide a portal for bacterial invasion of subcutaneous tissues. In some cases of refractory asthma, treatment of the associated tinea pedis infection may induce remission in airway disease. Very often, protracted topical and/or oral antifungal agents are required to treat this often frustrating and morbid disease. An evaluation for underlying immuno-suppression or diabetes may be indicated in patients with refractory disease.
Highlights
Dermatophytic infection of the skin can manifest in different anatomical regions of the body and have been named
A recent study showed that T. rubrum accounted for over 76% of all dermatophyte infections, including tinea pedis [1] and may account for over 2/3 of all tinea pedis infections
Of the 20 patients with athlete's foot, all had gram-positive bacteria isolated from their ipsilateral interdigital web space, and 85% (17 of the 20 cases) of these had β-hemolytic streptococci present. β-hemolytic streptococci were found significantly more often in patients with cellulitis and tinea pedis than in tinea pedis patients alone (p < 0.01)
Summary
Dermatophytic infection of the skin can manifest in different anatomical regions of the body and have been named. A patient may be referred for evaluation of recurrent cellulitis resulting from a tinea pedis infection rather than from immune deficiency. This review will discuss the clinical features of tinea pedis infection, the pathogens incriminated, and the current treatment options for patients with this disease. Tinea infections between the toes are common due to high moisture content and occlusion and often present with itching, burning, and/or malodor We show a man with dry-type tinea pedis in the third interspace. A thorough examination of the patient's feet and inter-digital spaces will often reveal evidence of recent or active tinea pedis Treatment of this condition could result in amelioration of the cellulitis episodes.
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