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Patient Story
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An 8-year-old boy presents with itching between his toes for 1 month (Figure 125-1). The pediatrician looks between his toes and sees maceration with white material. The patient was diagnosed with tinea pedis and treated successfully with a topical nonprescription antifungal medication.

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FIGURE 125-1

Tinea pedis seen in the interdigital spaces of an 8-year-old boy. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Tinea pedis is a common cutaneous infection of the feet caused by dermatophyte fungus. The clinical manifestation presents in 1 of 3 major patterns: interdigital, moccasin, and inflammatory. Concurrent fungal infection of the nails (onychomycosis) occurs frequently.

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Synonyms
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Athlete’s foot.

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Epidemiology
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  • Tinea pedis is thought to be the world’s most common dermatophytosis.1

  • 70 percent of the population will be infected with tinea pedis at some time.1

  • More commonly affects males than females.1

  • Prevalence increases with age and it is rare before adolescence.1

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Etiology and Pathophysiology
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  • A cutaneous fungal infection most commonly caused by Trichophyton rubrum.1

  • Trichophyton mentagrophytes and Epidermophyton floccosum follow in that order.

  • T. rubrum causes most tinea pedis and onychomycosis.

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Risk Factors
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  • Male gender.

  • Use of public showers, baths, or pools.2

  • Household member with tinea pedis infection.2

  • Certain occupations (miners, farmers, soldiers, meat factory workers, or marathon runners).2

  • Use of immunosuppressive drugs.

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Diagnosis
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Typical Distribution and Morphology
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Three types of tinea pedis:

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Some authors describe an ulcerative type (Figure 125-5).

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FIGURE 125-2

Tinea pedis seen in the interdigital space between the fourth and fifth digits. This is the most common area to see tinea pedis. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 125-3

Tinea pedis in the moccasin distribution. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 125-4

Vesicular tinea pedis with vesicles and bullae over the arch region of the foot. The arch is a typical location for vesiculobullous tinea pedis. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 125-5

Ulcerative tinea pedis with spreading vesicles related to a bacterial superinfection. The patient was treated with antifungals and antibiotics. (Used with permission from Richard ...

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