Tinea pedis aka Athlete’s foot.

Jungle rot
ECOPHARM CPD
Has 4 types

Dry type
Wet type (very common type, attempt to remove dead skin or use
keratolytic such as white field ointment may lead to wounds, serious in diabetic
patients).

Moccasin type (hard to treat because of the scaly skin (white field is good
for these cases) and sometimes recurrent, common also in diabetic patients but we use
keratolytic e.g. white field cautiously in diabetic patients .

Bollus type(inflammatory tinea pedis) is dangerous to treat especially in

diabetic patients as may result into wounds-possibly refer if not sure of
management)
 Types of tinea pedis

Dry type Wet type

 Types of tinea pedis

Moccasin Type Bullous type

Clinical presentation (patient complaints)

 Appearance of the feet ( abnormal scaling) and patients commonly

associate it with syphilis and erectile dysfunction.
 Smelling of the feet
 Itching of the feet
 Pain with bacterial superinfection.
 More in males than females.
 Predisposing Factors: Hot, humid weather, occlusive footwear;
excessive sweating. Transmission Walking barefoot on contaminated
floors.
 Types of tinea pedis
 Dry type
interdigital space between the toes shows erythema and scaling; the toenail is some times thickened,
indicative of associated distal subungual onychomycosis).
 Wet type
The greenish hue is caused by Pseudomonas aeruginosa superinfection of this moist intertriginous site), this
happens if treatment isn’t started with in time.
 Moccasin and interdigital tinea pedis.
Erythema and scale on the soles and lateral aspects of both feet in a slipper or moccasin distribution.
Maceration and scaling in the toe web spaces.
 Vesiculobullous tinea pedis
Pustules, vesicles, and bullae on the medial foot (arches, sides of feet). Type most often associated with
dermatophytid reaction
Differential diagnosis

Erythrasma (caused by bacteria Pitted keratolysis caused by bacteria

Corynebacterium minutissimum) (K. sedentarius)
Differential diagnosis

Pseudomonas aeruginosa webspace

Candida intertrigo infection (make light green-white lesions)
Management Tinea pedis
Management of Tinea pedis
Management of tinea pedis

Fungisafe tablets for 2-6weeks

Adults>40kg: 250mg tabs once daily
Fungisafe cream applied Fungican caps 150mg daily
twice daily for 2-4 weeks. 20-40kg: 125mg (1/2tab) once daily for 4-6weeks
Add 2 extra weeks after 10-20kg: 62.5mg (1/4 tab) once daily
fungal lesions have cleared
Pitted keratolysis management

 Etiology: Kytococcus sedentarius (produces two extracellular proteases that can digest
keratin)
 Distribution: plantar feet, webspaces of feet
 Predisposition: hyperhidrosis (over sweating) and occlusive footwear (gum boots)
Clinical findings: defects in thickly keratinized skin with eroded pits of variable depth
 Patient complaints: cosmetic appearance of feet is bad, spreading of the lesions, smelly
feet. Misconception of syphilis (find out??)
 Reoccurrence is very common especially if the risk factors such as sweating or occlusive
foot wear aren’t changed.
Pitted keratolysis

Web space involvement

Management of pitted keratolysis ( &
erythrasma)

 Prevention/Prophylaxis: Wash with benzoyl peroxide bar soap.

 Medicated powders (do not use corn starch powder).
 Topical antiseptic alcohol gels: isopropyl, ethanol.
 Topical Therapy Preferable: Benzoyl peroxide (2.5%) gel daily, after showering,
for 7 days.
 Topical erythromycin or clindamycin solution twice daily for 7 days. Sodium
fusidate ointment, mupirocin ointment or cream.
 Topical antifungal agents; clotrimazole, miconazole, or econazole. Systemic
Antibiotic Therapy A macrolide or a tetracycline for 7 days.
Practical management (pitted keratolysis)

 Doxycycline 100mg twice daily for 1 week

 Wash with benzoyl peroxide bar soap during (then after apply the Benzox 5%
gel) and after treatment
 Benzox 5% (benzoyl peroxide) 2.5% not readily available, after bathing and
drying the feet.
 Other therapies if need be! (antifungal, antibacterial)