Athlete's Foot

Athlete's foot is a term given to almost any inflammatory skin disease that affects the sole and the skin between the toes. It is usually scaly and maybe a red, raw-appearing eruption with weeping and oozing with small blisters. It affects the feet of athletes and non-athletes alike. Although it is frequently caused by a fungal infection, other causes may be indistinguishable without proper testing.

The medical name for fungal athlete's foot is tinea pedis. There are a variety of fungi that cause an athlete's foot, and these can be contracted in many locations, including gyms, locker rooms, swimming pools, communal showers, nail salons, and contaminated socks and clothing. The fungi can also be spread directly from person to person by contact.

Most people acquire fungus on their feet from walking barefoot in areas where someone else with athlete's foot has recently walked. Some people are simply more prone to this condition while others seem relatively resistant to it. Another colorful name for this condition is "jungle rot," often used by members of the armed services serving in tropical climates.

Fungal infections are promoted by warmth and moisture. There is some speculation that before enclosed shoes became common, tinea pedis were less prevalent. Up to 70% of the population may develop athlete's foot at some time. An infection by athlete's foot fungi does not confer any resistance to subsequent infections.

Risk factors for athlete's foot may include the following:

• Walking barefoot in wet, dark areas frequented by many other individuals like indoor swimming pool decks, communal showers, and locker rooms results in frequent exposure to pathogenic fungi (dermatophytes) that cause athlete’s foot.
• Wearing occlusive footwear is thought to play a significant role in the increased frequency of tinea pedis.
• Exposure to moisture either from excessive sweating or from an external source is a risk factor.
• Wearing the same shoes and socks for an extended period may damage the skin.
• Patients with diabetes are predisposed to develop tinea pedis.
• Some believe that eczema (atopic dermatitis) can predispose one to tinea pedis.
• It appears that many more men have tinea pedis than women.
• Pedicures performed in contaminated environments can spread disease.

Many individuals with athlete's foot have no symptoms at all and do not even know they have an infection. Many may think they simply have dry skin on the soles of their feet.

Common symptoms of athlete's foot typically include:

• various degrees of itching,
• stinging, and
• burning.

The skin may frequently peel, and in particularly severe cases, there may be some cracking, fissuring, pain, and itching in the toe webs. Occasionally, an athlete's foot can blister.

Fungal athlete's foot may cause a rash on one or both feet and even involve the hand. A "two feet and one hand" pattern is a very common presentation of an athlete's foot, especially in men.

• Hand fungal infections are called tinea manuum.
• Fungal athlete's foot may also be seen along with ringworm of the groin (especially in men) or hand(s).
• It is helpful to examine the feet whenever there is a fungal groin rash called tinea cruris, or jock itch.
• It is important to treat all areas of fungal infection at one time to avoid reinfection.
• Simply treating the soles and ignoring the concurrent fungal infection of toenails may result in recurrences of athlete's foot.

If an athlete's foot is caused by a fungus, it is potentially contagious. Some people do not develop an infection of the skin after exposure to the fungus. The exact cause of resistance or susceptibility to fungal infections is unknown.

There are many possible causes of foot rashes, such as:

• irritant or contact dermatitis,
• allergic rashes from shoes or other creams,
• pompholyx (dyshidrotic eczema),
• psoriasis,
• yeast infections, and
• bacterial infections (gram-negative toe web infection and erythrasma).

Since these conditions are often indistinguishable on superficial visual examination, your doctor needs to do his best to identify the precise cause. Since fungal infections are potentially curable, it is important not to miss this diagnosis.

Your physician may perform a simple test called a potassium hydroxide (KOH) preparation for microscopic fungal examination in the office or laboratory. This test can be used to confirm the presence of a fungal infection. This test is performed by using a microscope to examine small flakes of skin from the rash. Many dermatologists perform this test in their office with results available within minutes. Rarely, a small piece of skin may be removed and sent for biopsy or fungal culture to help confirm the diagnosis.

If you notice any redness, increased swelling, or bleeding, or if your infection is not clearing up, see your healthcare professional. If a bacterial infection is also occurring, an antibiotic pill may be necessary. If you have fungal nail involvement, are diabetic, or have a compromised immune system, you should also see your physician for treatment.

Dermatologists specialize in the treatment of skin disorders, including athlete's foot. You may find a board-certified dermatologist at http://www.aad.org. Additionally, family medicine physicians, internal medicine physicians, pediatricians, podiatrists (foot doctors), and other practitioners may also treat this common infection. Most primary care physicians can treat athlete's foot successfully.

The most reliable way to diagnose athlete’s foot is to correctly identify its cause. Fungal athlete's foot is relatively straightforward to diagnose and treat. Visualization of the fungus in skin scrapings removed from the affected areas of the feet is a painless and cost-effective method for diagnosis. Rarely, it is necessary to identify fungi in portions of skin removed during a biopsy. If no fungus is found, other causes of athlete's foot must be investigated.

Since there is no single cause for athlete’s foot there is no single treatment. Nevertheless, all causes of this condition benefit by promoting a dry, clean, and friction-free environment for the feet.

• Occlusive shoe materials, such as vinyl, which cause the feet to remain moist, provide an excellent area for the fungus to proliferate.
• Likewise, absorbent socks like cotton that wick water away from your feet may help.
• Some individuals who sweat excessively benefit from the application of antiperspirants like 20% aluminum chloride (Drysol).
• Powders can help keep your feet dry.
• Although counterintuitive, if your feet can be soaked in a solution of aluminum acetate (Burow's solution or Domeboro solution) and then air-dried with a fan, this can be very helpful if performed three or four times within 30 minutes.
• A home remedy of dilute white vinegar soaks, using one part vinegar and roughly four parts water, once or twice a day (as 10-minute foot soaks) may aid in treatment followed by evaporation can be helpful.

For fungus infection, there are plenty of options. Many medications are available, including:

• miconazole (Micatin, Zeasorb powder)
• econazole (Spectazole)
• clotrimazole (Lotrimin)
• terbinafine (Lamisil)
• naftifine (Naftin)
• butenafine (Mentax)
• ciclopirox (Loprox)
• ketoconazole (Nizoral)
• efinaconazole (Jublia)
• luliconazole (Luzu)
• sertaconazole (Ertaczo)
• sulconazole (Exelderm)
• tolnaftate (Tinactin)

Ask your healthcare professional or pharmacist for a recommendation. It is difficult to know which of these drugs is most effective since they have not been tested against each other. Cost is probably the most significant differentiating factor, and many are available without a prescription. Treatment for an athlete's foot should generally be continued for four weeks or at least one week after all of the skin symptoms have cleared.

More advanced or resistant cases of athlete's foot may require a course of an oral (pill) antifungal like:

• terbinafine (Lamisil),
• itraconazole (Sporanox), or
• fluconazole (Diflucan).

Laboratory blood tests to make sure there is no liver disease may be required before taking these pills.

Topical corticosteroid creams can act as a "fertilizer" for fungus and may worsen fungal skin infections by suppressing the body's immune defenses. These topical steroid medications have no role in treating fungal foot infections but can be quite effective in treating noninfectious causes of athlete’s foot.

If the fungal infection has spread to the toenails, the nails must also be treated to avoid reinfection of the feet. Often, the nails are initially ignored only to find the athlete's foot keeps recurring. It is important to treat all of the visible fungi at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.

Multiple home remedies are available, including vinegar soaks, dilute Clorox soaks, and shampoos like Head & Shoulders or Selsun Blue. Other reported but unverified remedies have included Vicks Vapor Rub and Epsom salts.

• Dilute vinegar soaks or sprays (roughly one part white household vinegar to four parts water)
• Dilute Clorox baths or soaks (approximately ¼ cup of household Clorox bleach in one bathtub of water)

Treatment options during pregnancy may include diluting vinegar soaks or sprays (roughly one part white household vinegar to four parts water) and Lotrimin cream twice a day for two to three weeks to the soles. Antifungal pills are generally not recommended during pregnancy because of the potential side effects and possible fetal harm. Always check with your OB/GYN before using any medication or treatment during pregnancy.

You will likely have a positive outcome and your athlete’s foot will resolve with the correct diagnosis.

Untreated, fungal athlete's foot can potentially spread to other body parts or other people, including family members. The fungus may spread locally to the legs, toenails, hands, fingernails, and essentially any body area.

• Fungal nail infection (onychomycosis) is very likely
• Groin fungus (tinea cruris)
• Body skin fungus (tinea corporis)
• Secondary bacterial infections

This type of fungus generally likes to live in the skin, hair, and nails. It does not invade deep, go into body organs, or go into the blood system.

Fungal infections of the nails are called tinea unguium or onychomycosis. Nail fungus may be very difficult to treat. Antifungal pills may be required in cases of more advanced toenail fungal infections.

People with diabetes, HIV/AIDS, cancer, or other immune problems may be more prone to all kinds of infections, including fungus. In patients with diabetes, fungal infections may lead to potentially dangerous foot ulcerations.

When the skin is injured or damaged, the natural protective skin barrier is broken. Bacteria and yeasts can then invade the broken skin. Bacteria can cause a bad smell. Bacterial infection of the skin and resulting inflammation is known as cellulitis. This is especially likely to occur in individuals with diabetes, chronic leg swelling, who have had veins removed (such as for heart bypass surgery), or in the elderly. Bacterial skin infections also occur more frequently in patients with impaired immune systems.

Since some people are simply more prone to fungal infections, they are also prone to repeated infection. Preventive measures include keeping your feet clean and dry, avoiding prolonged moist environments, using socks in airport security lines, removing shoes, and allowing the feet's skin to "breathe," avoiding walking barefoot, especially in public areas like swimming pools and gyms, avoiding contact with known infected people, and avoiding soaking and contaminated tool usage at nail salons. Weekly applications of topical antifungal foot cream or a sprinkling of antifungal foot powder (Zeasorb Foot Powder) into shoes may also be helpful.

It is imperative to take your nail instruments, including nail files, to any public nail salon, unless you know the salon practices strict instrument sterilization and/or uses all disposable supplies.

Use cotton socks whenever possible. Make sure any affected family members also treat their athlete's foot at the same time to avoid cross-infections.