Athlete's foot, known medically as tinea pedis, is a common skin
infection of the feet caused by fungus. Signs and symptoms often
include itching, scaling, and redness. In rare cases the skin may
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
Athlete's foot is caused by a number of different fungi. These
include species of Trichophyton, Epidermophyton, and Microsporum.
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 and in locker
rooms. 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 or seeing hyphae using a microscope.
Some methods of prevention include avoiding walking barefoot in public
showers, keeping the toenails short, wearing big enough shoes, and
changing socks daily. When infected, the feet should be kept dry
and clean and wearing sandals may help. Treatment can be either
with antifungal medication applied to the skin such as clotrimazole or
for persistent infections antifungal medication that are taken by
mouth such as terbinafine. The use of the cream is typically
recommended for four weeks.
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 1900s due to
the great use of shoes, health clubs, war, and travel.
1 Signs and symptoms
2.2 Risk factors
5.2 Oral treatments
7 See also
9 External links
Signs and symptoms
Athlete's foot is divided into four categories or presentations:
chronic interdigital athlete's foot, plantar (chronic scaly) athlete's
foot (aka "moccasin foot"), acute ulcerative tinea pedis, and
vesiculobullous athlete's foot. "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 is a type
of mucocutaneous disease characterized by vesicles and bullae
(blisters). Both vesicles and bullae are fluid-filled lesions, 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 (interdigital), with
the space between the fourth and fifth digits 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 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
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.
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
Because athlete's foot may itch, it may also elicit the scratch
reflex, causing the host to scratch the infected area before he or she
realizes 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
excoriations (open wounds), which are susceptible to bacterial
infection. Further scratching may remove scabs, inhibiting the healing
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
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
(ringworm) or tinea cruris (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 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
Athlete's foot is a form of dermatophytosis (fungal infection of the
skin), caused by dermatophytes, fungi (most of which are mold) which
inhabit dead layers of skin and digests 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
Epidermophyton floccosum. 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.
According to the 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 (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.
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 ("ringworm") when the torso or limbs are affected or
tinea cruris (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.
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. 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
Hyperhidrosis (abnormally increased sweating)
increases the risk of infection and makes treatment more
Microscopic view of cultured athlete's foot fungus
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
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 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
known to cause athlete's foot will demonstrate multiple septate
branching hyphae on microscopy.
Wood's lamp (black light), 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.
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.
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
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.
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.
Athlete's foot resolves without medication (resolves by itself) in
30–40% of cases.
Topical antifungal medication consistently
produce 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. 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
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 60 Celsius. 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.
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.
There are many topical antifungal drugs useful in the treatment of
athlete's foot including: miconazole nitrate, clotrimazole, tolnaftate
(a synthetic thiocarbamate), terbinafine hydrochloride, butenafine
hydrochloride and undecylenic acid. 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 terbinafine once daily for one week or butenafine once
daily for two weeks is effective in most cases of athlete's foot and
is more effective than application of miconazole or clotrimazole.
Plantar-type athlete's foot is more resistant to topical treatments
due to the presence of thickened hyperkeratotic skin on the sole of
Keratolytic and humectant medications such as urea,
salicyclic acid (Whitfield's ointment), and lactic acid are useful
adjunct medications and improve penetration of antifungal agents into
the thickened skin.
Topical glucocorticoids are sometimes
prescribed to alleviate inflammation and itching associated with the
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.
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
Globally, fungal infections affect about 15% of the population and
affects one out of five adults.
Athlete's foot is common in
individuals who wear occlusive shoes. Countries and regions
where going barefoot 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
Toenail fungus, tinea unguium, an infection affecting the toenails
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Media related to
Athlete's foot at Wikimedia Commons
V · T · D
Fungal infection and mesomycetozoea (B35–B49, 110–118)
Tinea = skin;
endothrix) = hair
Tinea barbae/tinea capitis
Tinea pedis (athlete's foot)
White superficial onychomycosis
Distal subungual onychomycosis
Proximal subungual onychomycosis
Tinea corporis gladiatorum
Coccidioides immitis/Coccidioides posadasii
Primary cutaneous coccidioidomycosis. Primary pulmonary
Primary cutaneous histoplasmosis
Primary pulmonary histoplasmosis
Progressive disseminated histoplasmosis
North American blastomycosis
South American blastomycosis
Congenital cutaneous candidiasis
Erosio interdigitalis blastomycetica
Allergic bronchopulmonary aspergillosis
Primary cutaneous aspergillosis
Fonsecaea pedrosoi/Fonsecaea compacta/Phialophora verrucosa
Conidiobolus coronatus/Conidiobolus incongruus
Enterocytozoon bieneusi/Encephalitozoon intestinalis
Granuloma gluteale infantum
Diseases of the skin and appendages by morphology
epidermal inclusion cyst
dermatofibroma (benign fibrous histiocytoma)
infantile digital fibromatosis
granular cell tumor
lichen simplex chronicus
langerhans cell histiocytosis
systemic lupus erythematosus
pityriasis rubra pilaris
acute contact dermatitis
porphyria cutanea tarda
epidermolysis bullosa simplex
insect bite reactions
transient acantholytic dermatosis
pityriasis lichenoides et varioliformis acuta
subcorneal pustular dermatosis
idiopathic guttate hypomelanosis
hypopigmented mycosis fungoides
systemic lupus erythematosus
fixed drug eruption
disseminated intravascular coagulation
lichen sclerosis et atrophicus
systemic lupus erythematosus
loose anagen syndrome
acne keloidalis nuchae
mucous membrane pemphigoid