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Review
. 2023 Jun 29:12:2023-5-1.
doi: 10.7573/dic.2023-5-1. eCollection 2023.

Tinea pedis: an updated review

Alexander Kc Leung  1 , Benjamin Barankin  2 , Joseph M Lam  3 , Kin Fon Leong  4 , Kam Lun Hon  5
Affiliations
Review

Tinea pedis: an updated review

Alexander Kc Leung et al. Drugs Context. .

Abstract

Background: Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis.

Methods: A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years.

Results: Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients.

Conclusion: Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.

Keywords: Trichophyton interdigitale; Trichophyton rubrum; athlete’s foot; dermatophytosis; interdigital; moccasin; vesiculobullous.

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Conflict of interest statement

Disclosure and potential conflicts of interest: AKCL and KLH are associate editors of Drugs in Context and confirm that this article has no other conflicts of interest otherwise. This manuscript was sent out for independent peer review. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2023/06/dic.2023-5-1-COI.pdf

Figures

Figure 1
Figure 1
Interdigital tinea pedis presenting with maceration, desquamation and fissuring between the toes.
Figure 2
Figure 2
Interdigital tinea pedis presenting with erythema and scaling between the toes and the adjacent skin.
Figure 3
Figure 3
Diffuse scale and erythema on the sole and medial aspect of the foot in a patient with hyperkeratotic (moccasin-type) tinea pedis.
Figure 4
Figure 4
Vesiculobullous (inflammatory) tinea pedis presenting with pruritic vesicles and bullae over a background of erythema on the dorsal surface of the right foot.
Figure 5
Figure 5
Vesiculobullous (inflammatory) tinea pedis presenting with pruritic vesicles and bullae over a background of erythema on the medial plantar surface of the left foot.
Figure 6
Figure 6
Tinea incognito in a patient with tinea pedis treated with topical corticosteroid resulting in loss of typical appearance of the lesion.
See this image and copyright information in PMC

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