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Athlete’s foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth. The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi.
The signs of athlete’s foot, singly or combined, are dry skin, itching, scaling, inflammation, and blisters.
Tinea pedis is a dermatophytosis of the feet, whereas tinea manus affects the palmar and interdigital areas of the hand.
Tinea manus may be acquired by direct contact with an infected person or animal, the soil, or autoinoculation.
Usually bilateral with patchy or diffuse scaling limited to the thick skin, soles, and the lateral and medial aspects of the feet, this is also known as “moccasin-type” tinea pedis. Unilateral tinea manuum commonly occurs in association with hyperkeratotic tinea pedis, resulting in the “two feet-one hand syndrome” .
The vesiculo-bullous and acute ulcerative types commonly produce a vesicular id reaction, either as a dyshidroticlike distribution on the hands or on the lateral foot or toes. For vesiculo-bullous lesions, examination of the roofs yields the highest rate of positivity on KOH examination. Histologically, hyperkeratotic tinea pedis or tinea manuum is characterized by acanthosis, hyperkeratosis, and a sparse, chronic, superficial perivascular infiltrate in the dermis. It may affect just the web spaces, spread to the soles or cover the entire sole of the foot in a "moccasin" distribution.

Fungal infection of the feet usually starts between the toes--often in the web spaces between the 3rd, 4th and 5th toes.
The morphology of tinea pedis may be eczematous, with redness and scale, or it may be microvesicular, like pompholyx. Rarely, an allergic contact dermatitis to an allergen in shoe wear (shoe dermatitis) may be the cause.
If the KOH is negative, but suspicion is high, apply a tape to the side of foot and ask the patient to reapply whenever it falls off. Topical terbinafine (OTC) has a quicker onset of action compared to clotrimazole and can lead to significant improvement in many patients after one week of BID therapy. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete’s foot. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The prevalence of tinea pedis is approximately 10 percent, primarily attributable to modern occlusive footwear, although increased worldwide travel has also been implicated.
However, it is nearly always associated with tinea pedis and occurs most commonly in the hand used to excoriate the feet. When tinea manus extend to the dorsum of a hand, it assumes the clinical pattern of tinea corporis . Vesiculo-bullous forms display spongiosis, parakeratosis, and sub-corneal or spongiotic intraepithelial vesiculation. In this case, topical antifungals are ineffective and topical steroids help but do not clear.

The incidence of tinea pedis is higher among those using communal baths, showers, or pools. Oral antifungals are often required for treatment due to the high incidence of concomitant onychomycosis and relapse.
At some point, the dermatophyte can extend to the tips of the toes and then invade the undersurface of the nail, causing onychomycosis.
Clues that tinea is the cause include i) coexistent onychomycosis, ii) a moccasin distribution (redness and scale along the entire sole and extending up a cm onto the sides), and iii) involvement of the web spaces. Zeasorb AF super absorbent powder may be routinely put into the shoes to both kill the fungus and keep things dry.
Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body. Alternatively, it may extend across the sole of the foot and eventually cause a moccasin-type distribution. If the patient wants a prescription, any of a variety of prescription antifungals are effective.
Any fungal infection of the nails may lead to recurrence and should be treated (see onychomycosis). A patient handout with suggestions for preventing onychoycosis is available and may be helpful here.

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