Tinea Pedis

Diagnosis: Tinea Pedis

tinea pedis

Clinical Presentation

tinea pedis

Clinical History

Scaling, maceration, and pruritus of feet, especially interdigital spaces. Chronic moccasin-type: diffuse plantar scaling. Vesiculobullous: inflammatory blisters on arch.

Treatment

Topical: terbinafine, clotrimazole, miconazole BID × 2-4 weeks. Moccasin type: oral terbinafine 250mg/day × 2-6 weeks. Keep feet dry. Antifungal powder maintenance.

Differential Diagnosis

• Contact dermatitis • Dyshidrotic eczema • Psoriasis (palmoplantar) • Pitted keratolysis • Erythrasma • Juvenile plantar dermatosis • Secondary syphilis (plantar)

Key Learnings

• Most common dermatophyte infection — T. rubrum most common causative organism • Three clinical patterns: interdigital (most common), moccasin (chronic, T. rubrum), vesiculobullous (inflammatory) • "Two feet, one hand" syndrome: bilateral tinea pedis + unilateral tinea manuum — characteristic pattern • Interdigital tinea pedis is a major risk factor for lower extremity cellulitis • KOH confirms diagnosis — roof of vesicle or leading edge of scale • Moccasin type requires systemic antifungals — topical treatment alone is inadequate • Treat tinea pedis to prevent recurrent cellulitis in patients with venous insufficiency

Tags: dermatology, kodachrome, tinea pedis