athlete's foot
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Athlete's foot, known medically as ''tinea pedis'', is a common
skin infection A skin infection is an infection of the skin in humans and other animals, that can also affect the associated soft tissues such as loose connective tissue and mucous membranes. They comprise a category of infections termed skin and skin structur ...
of the feet caused by a
fungus A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from t ...
. Signs and 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 Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple ar ...
''. Athlete's foot is caused by a number of different
fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ...
, including species of ''
Trichophyton ''Trichophyton'' is a genus of fungi, which includes the parasitic varieties that cause tinea, including athlete's foot, ringworm, jock itch, and similar infections of the nail, beard, skin and scalp. Trichophyton fungi are molds characterize ...
'', ''
Epidermophyton ''Epidermophyton'' is a genus of fungus causing superficial and cutaneous mycoses, including ''E. floccosum'', and causes tinea corporis (ringworm), tinea cruris (jock itch), tinea pedis Dermatophytosis, also known as ringworm, is a fung ...
'', and ''
Microsporum ''Microsporum'' is a genus of fungi that causes tinea capitis, tinea corporis, ringworm, and other dermatophytoses (fungal infections of the skin). ''Microsporum'' forms both macroconidia (large asexual reproductive structures) and microconi ...
''. The condition is typically acquired by coming into contact with infected skin, or fungus in the environment. Common places where the fungi can survive are around
swimming pools A swimming pool, swimming bath, wading pool, paddling pool, or simply pool, is a structure designed to hold water to enable swimming or other leisure activities. Pools can be built into the ground (in-ground pools) or built above ground (a ...
and in
locker rooms A changing-room, locker-room, (usually in a sports, theater, or staff context) or changeroom (regional use) is a room or area designated for changing one's clothes. Changing-rooms are provided in a semi-public situation to enable people to ch ...
. They may also be spread from other animals. Usually diagnosis is made based on signs and symptoms; however, it can be confirmed either by
culture Culture () is an umbrella term which encompasses the social behavior, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups ...
or seeing hyphae using a
microscope A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisi ...
. Athlete's foot is not limited to just athletes: it can be caused by going
barefoot Barefoot is the state of not wearing any footwear. There are health benefits and some risks associated with going barefoot. Shoes, while they offer protection, can limit the flexibility, strength, and mobility of the foot and can lead to h ...
in public showers, letting toenails grow too long, wearing shoes that are too tight, and not changing socks daily. It can be treated with topical
antifungal medication An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryp ...
s such as
clotrimazole Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock i ...
or, for persistent infections, using oral antifungal medications such as
terbinafine Terbinafine, sold under the brand name Lamisil among others, is an antifungal medication used to treat pityriasis versicolor, fungal nail infections, and ringworm including jock itch and athlete's foot. It is either taken by mouth or applied to ...
. Topical creams are typically recommended to be used for four weeks. Keeping infected feet dry and wearing sandals also assists with treatment. Athlete's foot was first medically described in 1908. 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. Historically it is believed to have been a rare condition that became more frequent in the 20th century due to the greater use of shoes,
health clubs A health club (also known as a fitness club, fitness center, health spa, and commonly referred to as a gym) is a place that houses exercise equipment for the purpose of physical exercise. In recent years, the number of fitness and health se ...
, war, and travel.


Signs and symptoms

Athlete's foot is divided into four categories or presentations: chronic interdigital, plantar (chronic scaly; aka "moccasin foot"), acute ulcerative, and vesiculobullous. "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. A
vesiculobullous disease A vesiculobullous disease is a type of mucocutaneous disease characterized by vesicles and bullae (i.e. blisters). Both vesicles and bullae are fluid-filled lesions, and they are distinguished by size (vesicles being less than 5–10 mm and b ...
is a type of
mucocutaneous disease A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this s ...
characterized by
vesicles Vesicle may refer to: ; In cellular biology or chemistry * Vesicle (biology and chemistry), a supramolecular assembly of lipid molecules, like a cell membrane * Synaptic vesicle ; In human embryology * Vesicle (embryology), bulge-like features o ...
and bullae (blisters). Both vesicles and bullae are fluid-filled
lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...
s, and they are distinguished by size (vesicles being less than 5–10 mm and bulla being larger than 5–10 mm, depending upon what definition is used). Athlete's foot occurs most often between the
toes Toes are the digits (fingers) of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being '' digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being '' pl ...
(interdigital), with the space between the fourth and fifth digits (the little toe and the fore toe) most commonly affected. 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 Red is the color at the long wavelength end of the visible spectrum of light, next to orange and opposite violet. It has a dominant wavelength of approximately 625–740 nanometres. It is a primary color in the RGB color model and a secondar ...
or ulcerative ( scaly, flaky, with soft and white if skin has been kept wet), with or without itching. 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 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. 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 Vesicle may refer to: ; In cellular biology or chemistry * Vesicle (biology and chemistry), a supramolecular assembly of lipid molecules, like a cell membrane * Synaptic vesicle ; In human embryology * Vesicle (embryology), bulge-like features o ...
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 ''Streptococcus pyogenes'' is a species of Gram-positive, aerotolerant bacteria in the genus '' Streptococcus''. These bacteria are extracellular, and made up of non-motile and non-sporing cocci (round cells) that tend to link in chains. They ...
'' or '' Staphylococcus aureus''.


Complications

As the disease progresses, the skin may crack, leading to bacterial skin infection and inflammation of the lymphatic vessels.The Merck Manual Professional Edition tinea pedis page
. Retrieved 16 January 2015.
If allowed to grow for too long, athlete's foot fungus may spread to infect the
toenails A nail is a claw-like plate found at the tip of the fingers and toes on most primates. Nails correspond to the claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin, which is a polymer. ...
,
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
webpage o
Athlete's Foot
. Retrieved 14 January 2015.
feeding on the
keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...
in them, a condition called
onychomycosis Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, ...
. Because athlete's foot may
itch Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasant ...
, it may also elicit the scratch reflex, causing the host to scratch the infected area before they realize it. Scratching can further damage the skin and worsen the condition by allowing the fungus to more easily spread and thrive. The itching sensation associated with athlete's foot can be so severe that it may cause hosts to scratch vigorously enough to inflict
excoriation A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this s ...
s (open wounds), which are susceptible to bacterial infection. Further scratching may remove scabs, inhibiting the healing process. Scratching infected areas may also spread the fungus to the fingers and under the fingernails. If not washed away soon enough, it can infect the fingers and fingernails, growing in the skin and in the nails (not just underneath). After scratching, it can be spread to wherever the person touches, including other parts of the body and to one's environment. Scratching also causes infected skin scales to fall off into one's environment, leading to further possible spread. When athlete's foot fungus or infested skin particles spread to one's environment (such as to clothes, shoes, bathroom, etc.) whether through scratching, falling, or rubbing off, not only can they infect other people, they can also reinfect (or further infect) the host they came from. For example, infected feet infest one's socks and shoes which further expose the feet to the fungus and its spores when worn again. The ease with which the fungus spreads to other areas of the body (on one's fingers) poses another complication. When the fungus is spread to other parts of the body, it can easily be spread back to the feet after the feet have been treated. And because the condition is called something else in each place it takes hold (e.g.,
tinea corporis Tinea corporis is a fungal infection of the body, similar to other forms of tinea. Specifically, it is a type of dermatophytosis (or ringworm) that appears on the arms and legs, especially on glabrous skin; however, it may occur on any superficial ...
(ringworm) or
tinea cruris Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates. Typically, over the upper inner ...
(jock itch)), persons infected may not be aware it is the same disease. Some individuals may experience an allergic response to the fungus called an
id reaction Id reactions (also known as "disseminated eczema," and "generalized eczema") are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalis ...
in which blisters or vesicles can appear in areas such as the hands, chest, and arms. Treatment of the underlying infection typically results in the disappearance of the id reaction.


Causes

Athlete's foot is a form of
dermatophytosis Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple a ...
( fungal infection of the skin), caused by
dermatophyte Dermatophyte (from Greek '' derma'' "skin" ( GEN ''dermatos'') and ''phyton'' "plant") is a common label for a group of fungus of ''Arthrodermataceae'' that commonly causes skin disease in animals and humans. Traditionally, these anamorphic (a ...
s, fungi (most of which are mold) which inhabit dead layers of skin and digest keratin. Dermatophytes are
anthropophilic In parasitology, anthropophilia, from the Greek ἅνθρωπος (anthrōpos, "human being") and φιλία (philia, "friendship" or "love"), is a preference of a parasite or dermatophyte for humans over other animals.Braun-Falco, Otto (2000). ' ...
, meaning these
parasitic Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson ha ...
fungi prefer human hosts. Athlete's foot is most commonly caused by the molds known as ''
Trichophyton rubrum ''Trichophyton rubrum'' is a dermatophytic fungus in the phylum Ascomycota. It is an exclusively clonal, anthropophilic saprotroph that colonizes the upper layers of dead skin, and is the most common cause of athlete's foot, fungal infectio ...
'' and '' T. mentagrophytes'', but may also be caused by ''
Epidermophyton floccosum ''Epidermophyton floccosum'' is a filamentous fungus that causes skin and nail infections in humans. This anthropophilic dermatophyte can lead to diseases such as tinea pedis (athlete's foot), tinea cruris, tinea corporis and onychomycosis. Diag ...
''. Most cases of athlete's foot in the general population are caused by ''T. rubrum''; however, the majority of athlete's foot cases in athletes are caused by ''T. mentagrophytes''.


Transmission

According to the UK's
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
, "Athlete's foot is very contagious and can be spread through direct and indirect contact."National Health Service's webpage on Athlete's Foot causes
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 (clothes, towels, etc.) or surfaces (such as bathroom, shower, or locker room floors). The fungi that cause 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. When the fungus has spread to pets, it can subsequently spread to the hands and fingers of people who pet them. If a pet frequently gnaws upon itself, it might not be fleas it is reacting to, it may be the insatiable itch of tinea. One way to contract athlete's foot is to get a fungal infection somewhere else on the body first. The fungi causing athlete's foot may spread from other areas of the body to the feet, usually by touching or scratching the affected area, thereby getting the fungus on the fingers, and then touching or scratching the feet. While the fungus remains the same, the name of the condition changes based on where on the body the infection is located. For example, the infection is known as
tinea corporis Tinea corporis is a fungal infection of the body, similar to other forms of tinea. Specifically, it is a type of dermatophytosis (or ringworm) that appears on the arms and legs, especially on glabrous skin; however, it may occur on any superficial ...
("ringworm") when the torso or limbs are affected or
tinea cruris Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates. Typically, over the upper inner ...
(jock itch or dhobi itch) when the groin is affected. Clothes (or shoes), body heat, and sweat can keep the skin warm and moist, just the environment the fungus needs to thrive.


Risk factors

Besides being exposed to any of the modes of transmission presented above, there are additional risk factors that increase one's chance of contracting athlete's foot. 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.Mayo Clinic website, Athlete's Foot Risk Factors
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 athlete's foot.
Hyperhidrosis Hyperhidrosis is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. Although primarily a benign physical burden, hyperhidrosis can deteriorate quality of life from a psycholog ...
(abnormally increased sweating) increases the risk of infection and makes treatment more difficult.The Merck Manual Professional Edition. Tinea Pedis


Diagnosis

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. If the diagnosis is uncertain, direct microscopy of a
potassium hydroxide Potassium hydroxide is an inorganic compound with the formula K OH, and is commonly called caustic potash. Along with sodium hydroxide (NaOH), KOH is a prototypical strong base. It has many industrial and niche applications, most of which exp ...
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 Candidiasis is a fungal infection due to any type of '' Candida'' (a type of yeast). When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth ...
,
pitted keratolysis Pitted keratolysis (also known as Keratolysis plantare sulcatum, Keratoma plantare sulcatum, and Ringed keratolysis) is a bacterial skin infection of the foot. The infection is characterized by craterlike pits on the sole of the feet and toes, pa ...
, erythrasma,
contact dermatitis Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...
,
eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can ...
, or
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
.
Dermatophyte Dermatophyte (from Greek '' derma'' "skin" ( GEN ''dermatos'') and ''phyton'' "plant") is a common label for a group of fungus of ''Arthrodermataceae'' that commonly causes skin disease in animals and humans. Traditionally, these anamorphic (a ...
s known to cause athlete's foot will demonstrate multiple septate branching hyphae on microscopy. A
Wood's lamp A blacklight, also called a UV-A light, Wood's lamp, or ultraviolet light, is a lamp that emits long-wave (UV-A) ultraviolet light and very little visible light. One type of lamp has a violet filter material, either on the bulb or in a separat ...
(black light), although useful in diagnosing fungal infections of the scalp (
tinea capitis Tinea capitis (also known as "herpes tonsurans", "ringworm of the hair", "ringworm of the scalp", "scalp ringworm", and "tinea tonsurans") is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermato ...
), is not usually helpful in diagnosing athlete's foot, since the common dermatophytes that cause this disease do not fluoresce under ultraviolet light.


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 A nail clipper (also called nail clippers, a nail trimmer, a nail cutter or nipper type) is a hand tool used to trim fingernails, toenails and hangnails. Design Nail clippers are usually made of stainless steel but can also be made of plastic a ...
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
sandal Sandals are an open type of footwear, consisting of a sole held to the wearer's foot by straps going over the instep and around the ankle. Sandals can also have a heel. While the distinction between sandals and other types of footwear can ...
s while walking through communal areas such as gym showers and locker rooms. According to the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
, "Nails should be clipped short and kept clean. Nails can house and spread the infection."Centers for Disease Control webpage on Athlete's Foot
. Retrieved 11 January 2015.
Recurrence of athlete's foot can be prevented with the use of antifungal powder on the feet. The fungi (molds) that cause athlete's foot require warmth and moisture to survive and grow. There is an increased risk of infection with exposure to warm, moist environments (e.g., occlusive footwear—shoes or boots that enclose the feet) and in shared humid environments such as communal showers, shared pools, and treatment tubs.
Chlorine bleach Bleach is the generic name for any chemical product that is used industrially or domestically to remove color (whitening) from a fabric or fiber or to clean or to remove stains in a process called bleaching. It often refers specifically, to ...
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. 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. Athlete's foot can be transmitted by sharing footwear with an infected person. Hand-me-downs and purchasing used shoes are other forms of shoe-sharing. Not sharing also applies to towels, because, though less common, fungi can be passed along on towels, especially damp ones.


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 A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
. Because the outer skin layers are damaged and susceptible to reinfection, topical treatment generally continues until all layers of the skin are replaced, about 2–6 weeks after symptoms disappear. Keeping feet dry and practicing good hygiene (as described in the above section on prevention) is crucial for killing the fungus and preventing reinfection. Treating the feet is not always enough. Once socks or shoes are infested with fungi, wearing them again can reinfect (or further infect) the feet. Socks can be effectively cleaned in the wash by adding bleach or by washing in water 60 °C (140 °F). 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 (such as toenails, hands, torso, etc.). 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.
Allylamine Allylamine is an organic compound with the formula C3H5NH2. This colorless liquid is the simplest stable unsaturated amine. Production and reactions All three allylamines, mono-, di-, and triallylamine, are produced by the treating allyl chlor ...
s such as terbinafine are considered more efficacious than
azole Azoles are a class of five-membered heterocyclic compounds containing a nitrogen atom and at least one other non-carbon atom (i.e. nitrogen, sulfur, or oxygen) as part of the ring. Their names originate from the Hantzsch–Widman nomenclature. T ...
s for the treatment of athlete's foot. Severe or prolonged fungal skin infections may require treatment with oral antifungal medication.


Topical treatments

There are many
topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
antifungal drugs useful in the treatment of athlete's foot including: miconazole nitrate,
clotrimazole Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock i ...
,
tolnaftate Tolnaftate ( INN) is a synthetic thiocarbamate used as an anti-fungal agent that may be sold without medical prescription in most jurisdictions. It is supplied as a cream, powder, spray, liquid, and liquid aerosol. Tolnaftate is used to treat ...
(a synthetic thiocarbamate), terbinafine hydrochloride, butenafine hydrochloride and
undecylenic acid Undecylenic acid is an organic compound with the formula CH2=CH(CH2)8CO2H. It is an unsaturated fatty acid. It is a colorless oil. Undecylenic acid is mainly used for the production of Nylon-11 and in the treatment of fungal infections of the s ...
. The fungal infection may be treated with topical antifungal agents, which can take the form of a spray, powder, cream, or gel. Topical application of an antifungal cream such as butenafine once daily for one week or
terbinafine Terbinafine, sold under the brand name Lamisil among others, is an antifungal medication used to treat pityriasis versicolor, fungal nail infections, and ringworm including jock itch and athlete's foot. It is either taken by mouth or applied to ...
once daily for two weeks is effective in most cases of athlete's foot and is more effective than application of
miconazole Miconazole, sold under the brand name Monistat among others, is an antifungal medication used to treat ring worm, pityriasis versicolor, and yeast infections of the skin or vagina. It is used for ring worm of the body, groin (jock itch), and ...
or
clotrimazole Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock i ...
. Plantar-type athlete's foot is more resistant to topical treatments due to the presence of thickened hyperkeratotic skin on the sole of the foot.
Keratolytic Keratolytic () therapy is a type of medical treatment to remove warts, calluses and other lesions in which the epidermis produces excess skin. In this therapy, acidic topical medicines, such as Whitfield's ointment or Jessner's solution, are ap ...
and humectant medications such as
urea Urea, also known as carbamide, is an organic compound with chemical formula . This amide has two amino groups (–) joined by a carbonyl functional group (–C(=O)–). It is thus the simplest amide of carbamic acid. Urea serves an important ...
,
salicyclic acid Salicylic acid is an organic compound with the formula HOC6H4CO2H. A colorless, bitter-tasting solid, it is a precursor to and a active metabolite, metabolite of aspirin (acetylsalicylic acid). It is a plant hormone, and has been listed by the ...
( Whitfield's ointment), and
lactic acid Lactic acid is an organic acid. It has a molecular formula . It is white in the solid state and it is miscible with water. When in the dissolved state, it forms a colorless solution. Production includes both artificial synthesis as well as nat ...
are useful adjunct medications and improve penetration of antifungal agents into the thickened skin. Topical
glucocorticoids Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebr ...
are sometimes prescribed to alleviate inflammation and
itching Itch (also known as pruritus) is a Wikt:sensation, sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of Sensory system, sensory experience. Itch has many similarities to pain, ...
associated with the infection. A solution of 1%
potassium permanganate Potassium permanganate is an inorganic compound with the chemical formula KMnO4. It is a purplish-black crystalline salt, that dissolves in water as K+ and , an intensely pink to purple solution. Potassium permanganate is widely used in the c ...
dissolved in hot water is an alternative to antifungal drugs. Potassium permanganate is a
salt Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quant ...
and a strong
oxidizing agent An oxidizing agent (also known as an oxidant, oxidizer, electron recipient, or electron acceptor) is a substance in a redox chemical reaction that gains or " accepts"/"receives" an electron from a (called the , , or ). In other words, an oxi ...
.


Oral treatments

For severe or refractory cases of athlete's foot oral
terbinafine Terbinafine, sold under the brand name Lamisil among others, is an antifungal medication used to treat pityriasis versicolor, fungal nail infections, and ringworm including jock itch and athlete's foot. It is either taken by mouth or applied to ...
is more effective than
griseofulvin Griseofulvin is an antifungal medication used to treat a number of types of dermatophytoses (ringworm). This includes fungal infections of the nails and scalp, as well as the skin when antifungal creams have not worked. It is taken by mouth. C ...
.
Fluconazole Fluconazole is an antifungal medication used for a number of fungal infections. This includes candidiasis, blastomycosis, coccidiodomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor. It is also used to pr ...
or
itraconazole Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given by mo ...
may also be taken orally for severe athlete's foot infections. The most commonly reported adverse effect from these medications is gastrointestinal upset.


Epidemiology

Globally,
fungal infections Fungal infection, also known as mycosis, is disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common ti ...
affect about 15% of the population and 20% of adults. Additionally, 70% of the population will experience Athlete's foot at some point in life. Athlete's foot is common in individuals who wear unventilated (occlusive) footwear, such as rubber boots or vinyl shoes. Upon exposure to an Athlete's foot-causing fungus, the moist conditions generated from poor foot ventilation promotes growth of the fungus on the foot or between the toes. Occupationally, studies have shown increased prevalence of Athlete's foot among miners, soldiers, and athletes. Likewise, activities such as marathon running have seen increased prevalence of Athlete's foot. Countries and regions where going
barefoot Barefoot is the state of not wearing any footwear. There are health benefits and some risks associated with going barefoot. Shoes, while they offer protection, can limit the flexibility, strength, and mobility of the foot and can lead to h ...
is more common experience much lower rates of athlete's foot than do populations which habitually wear shoes; as a result, the disease has been called "a penalty of civilization". Studies have demonstrated that men are infected 2–4 times more often than women. Cases of Athlete's foot were first documented around 1916 during World War 1, where infection among soldiers was common. By 1928 it was estimated that nearly ten million Americans with cases of Athlete's foot; the alarming prevalence of the disease caused for public health concern. In the following year, an epidemiologic study was conducted on incoming freshman to the University of California; it was found that 53% of incoming freshman men had Athlete's foot and by year's end that number had risen to 78%. Prevalence of the disease increased in the 1930's, specifically among individuals of higher socioeconomic status; these individuals had more access to common shared spaced such as pools, colleges, and athletic clubs where transmission of Athlete's foot-causing fungus was common. Prevalence in the United States was high enough to call for the use of sterilizing footbaths in the 1932 Olympics in Los Angeles. It was at this time public health officials adopted the idea that Athletes foot was a product of modernity and that dealing with this disease was "a penalty of civilization" as many treatments proved ineffective. Antifungal properties of compounds such as undecylenic acid were studied in the 1940's; products containing zinc undecylenate were shown to be the most effective topical treatment for curing the condition. The use of orally ingested Griseofulvin was shown in the 1960's to be effective in acute cases of Athlete's foot. Likewise, recorded incidence of Athletes foot decreased among American soldiers in Vietnam who were given Griseofulvin as a preventative drug. In the 1990's research supported the use of itraconazole and the Allylamine known as terbinafine as drugs effective at eliminating Athlete's foot and also dermatophyte infections on other parts of the body. As of 2012, research has shown that terbinafine is 2.26 times as likely to cure Athlete's foot than treatment with Griseofulvin; comparative studies between itraconazole and terbinafine have shown little difference in effectiveness.


See also

* Toenail fungus, ''tinea unguium'', an infection affecting the toenails *
Trench foot Trench foot is a type of foot damage due to moisture. Initial symptoms often include tingling or itching which can progress to numbness. The feet may become red or bluish in color. As the condition worsens the feet can start to swell and sm ...
, due to moisture and decay


References


External links

* * {{Authority control Animal fungal diseases Foot diseases Mycosis-related cutaneous conditions Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate