Athlete’s Foot: Skin Infection of the Foot

Athlete’s foot, known medically as tinea pedis, is a common skin infection of the feet caused by fungus. Symptoms often include itching, scaling, cracking, and redness. In rare cases, the skin may blister. Athlete’s foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea. Globally, athlete’s foot affects about 15% of the population. Males are more often affected than females. It occurs most frequently in older children or younger adults. Siddha Spirituality of Swami Hardas Life System brings out in-depth e.g. symptoms, complications, causes, risk factors, diagnosis, prevention, treatments, and Siddha remedies for tinea pedis.

Athlete’s foot Symptoms

The athlete’s foot includes four categories:

• Chronic interdigital,
• Plantar (chronic scaly; aka moccasin foot),
• Acute ulcerative, and
• Vesiculobullous.

Chronic interdigital

Interdigital means between the toes. Plantar here refers to the sole of the foot. The ulcerative condition includes macerated lesions with scaly borders. Maceration is the softening and breaking down of skin due to extensive exposure to moisture.

Athlete’s foot occurs most often between the toes (interdigital), with the space between the fourth and fifth digits (the little toe and the fore toe) most commonly afflicted.

Cases of interdigital athlete’s foot caused by Trichophyton rubrum may be symptomless, it may itch, or the skin between the toes may appear red or ulcerative (scaly, flaky, with soft and white if the skin has been kept wet), with or without itching.

Ulcerative

An acute ulcerative variant of interdigital athlete’s foot caused by T. mentagrophytes is characterized by pain, maceration of the skin, erosions and fissuring of the skin, crusting, and an odor due to secondary bacterial infection.

Plantar

Plantar athlete’s foot (moccasin foot) is also caused by T. rubrum which typically causes asymptomatic, slightly erythematous plaques (areas of redness of the skin) to form on the plantar surface (sole) of the foot that are often covered by fine, powdery hyperkeratotic scales.

Vesiculobullous

The vesiculobullous type of athlete’s foot is less common and is usually caused by T. mentagrophytes and is characterized by a sudden outbreak of itchy blisters and vesicles on an erythematous base, usually appearing on the sole of the foot.

This subtype of athlete’s foot is often complicated by secondary bacterial infection by Streptococcus pyogenes or Staphylococcus aureus.

Athlete’s foot Complications

As the disease progresses, the skin may crack, leading to bacterial skin infection and inflammation of the lymphatic vessels. If allowed to grow for too long, athlete’s foot fungus may spread to infect the toenails, feeding on the keratin in them, a condition called onychomycosis.

The ease with which the fungus spreads to other areas of the body (on one’s fingers) poses another complication. Some individuals may experience an allergic response to the fungus called an id reaction in which blisters or vesicles can appear in areas such as the hands, chest, and arms. 

Athlete’s foot Causes

Athlete’s foot is a form of dermatophytosis (fungal infection of the skin), caused by dermatophytes, fungi that inhabit dead layers of skin and digest keratin. Dermatophytes are anthropophilic, meaning these parasitic fungi prefer human hosts.

Athlete’s foot is most commonly caused by the molds known as Trichophyton rubrum and T. mentagrophytes, but may also be caused by Epidermophyton floccosum. 

Transmission

According to the UK’s National Health Service, “Athlete’s foot is very contagious and can be spread through direct and indirect contact.” The disease may spread to others directly when they touch the infection.

People can contract the disease indirectly by coming into contact with contaminated items e.g. clothes, towels, etc, or surfaces (such as bathroom, shower, or locker room floors).

The fungi that cause an athlete’s foot can easily spread to one’s environment. Fungi rub off of fingers and bare feet, but also travel on the dead skin cells that continually fall off the body.

Athlete’s foot fungi and infested skin particles and flakes may spread to socks, shoes, clothes, to other people, pets (via petting), bed sheets, bathtubs, showers, sinks, counters, towels, rugs, floors, and carpets.

Athlete’s foot Risk factors

Persons who have had athlete’s foot before are more likely to become infected than those who have not. Adults are more likely to catch athlete’s foot than children.

Men have a higher chance of getting athlete’s foot than women. People with diabetes or weakened immune systems are more susceptible to the disease. HIV/AIDS hampers the immune system and increases the risk of acquiring an athlete’s foot.

Hyperhidrosis (abnormally increased sweating) increases the risk of infection and makes treatment more difficult.

Athlete’s foot Diagnosis

Medical history

When visiting a doctor, the basic diagnosis procedure applies. This includes checking the patient’s medical history and medical record for risk factors, a medical interview during which the doctor asks questions (such as about itching and scratching), and a physical examination.

Athlete’s foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area.

KOH test

If the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete’s foot and help rule out other possible causes, such as:

• Candidiasis,
• Pitted keratolysis,
• Erythrasma,
• Contact dermatitis,
• Eczema, or psoriasis.

Dermatophytes are known to cause athlete’s foot will demonstrate multiple septate branching hyphae on microscopy.

Blacklight

A Wood’s lamp (blacklight), although useful in diagnosing fungal infections of the scalp (tinea capitis), is not usually helpful in diagnosing athlete’s foot, since the common dermatophytes that cause this disease do not fluoresce under ultraviolet light.

Athlete’s foot Prevention

There are several preventive foot hygiene measures that can prevent athlete’s foot and reduce recurrence. Some of these include:

• Keeping the feet dry;
• Clipping toenails short;
• Using a separate nail clipper for infected toenails;
• Using socks made from well-ventilated cotton or synthetic moisture-wicking materials (to soak moisture away from the skin to help keep it dry);
• Avoiding tight-fitting footwear;
• Changing socks frequently, and wearing sandals while walking through communal areas such as gym showers and locker rooms.

According to the Centers for Disease Control and Prevention, “Nails should be clipped short and kept clean. Nails can house and spread the infection.” Recurrence of athlete’s foot can be prevented with the use of antifungal powder on the feet.

Chlorine bleach is a disinfectant and common household cleaner that kills mold. Cleaning surfaces with a chlorine bleach solution prevents the disease from spreading from subsequent contact. Cleaning bathtubs, showers, bathroom floors, sinks, and counters with bleach helps prevent the spread of the disease, including reinfection.

Avoid sharing

Keeping socks and shoes clean (using bleach in the wash) is one way to prevent fungi from taking hold and spreading. Avoiding the sharing of boots and shoes is another way to prevent transmission. Hand-me-downs and purchasing used shoes are other forms of shoe-sharing.

Athlete’s foot Treatment

Athlete’s foot resolves without medication (resolves by itself) in 30–40% of cases. Topical antifungal medication consistently produces much higher rates of cure.

Conventional treatment typically involves thoroughly washing the feet daily or twice daily, followed by the application of a topical medication. Treating the feet is not always enough. Washing with bleach may help with shoes, but the only way to be absolutely certain that one cannot contract the disease again from a particular pair of shoes is to dispose of those shoes.

To be effective, treatment includes all infected areas. Otherwise, the infection may continue to spread, including back to treated areas. For example, leaving fungal infection of the nail untreated may allow it to spread back to the rest of the foot, to become athlete’s foot once again.

Allylamines such as terbinafine are considered more efficacious than azoles for the treatment of athlete’s foot.

Severe or prolonged fungal skin infections may require treatment with oral antifungal medication.

Athlete’s foot Topical treatments

There are many topical antifungal drugs useful in the treatment of athlete’s foot that include:

• Miconazole nitrate,
• Clotrimazole,
• Tolnaftate,
• Terbinafine hydrochloride,
• Butenafine hydrochloride, and
• Undecylenic acid.

Topical application of an antifungal cream such as butenafine once daily for one week or terbinafine once daily for two weeks is effective in most cases of athlete’s foot and is more effective than application of miconazole or clotrimazole. 

A solution of 1% potassium permanganate dissolved in hot water is an alternative to antifungal drugs. Potassium permanganate is a salt and a strong oxidizing agent.

Oral treatments

For severe or refractory cases of athlete’s foot oral terbinafine is more effective than griseofulvin. Fluconazole or itraconazole may also be taken orally for severe athlete’s foot infections. The most commonly reported adverse effect from these medications is gastrointestinal upset.

Home remedies for Athlete’s foot

Over-the-counter treatments

There are a number of over-the-counter (OTC) treatments available for athlete’s foot. These can come as powders, sprays, ointments, and lotions. Many cases of athlete’s foot respond well to OTC treatments and may never require other options.

You can apply these treatments directly to the affected area and use them for at least 1 week after symptoms resolve to prevent the infection from immediately returning.

Hydrogen peroxide

 

Reference:

• https://en.wikipedia.org/wiki/Athlete%27s_foot
• https://www.healthline.com/health/home-remedies-for-athletes-foot#vicks-vaporub