Tinea pedis generally affects adolescent and adults. Predisposing
host factors include male gender, wearing occlusive shoes, and living in a warm and humid climate (Table 2).2 A medical history of immune suppression, diabetes mellitus, or peripheral vascular disease also place patients at an elevated
risk for tinea pedis.2 Exercising in public sports facilities, especially in community swimming pools, represent well-documented
risk factors for contracting tinea pedis, particularly for men over the age of 16.17 Patients who cohabitate with individuals affected by tinea pedis are also at risk for developing
tinea pedis as transmission can occur from contact with fomites, most commonly in the bath.8 There is also evidence to support that tinea pedis is more common in patients with certain dermatologic conditions such as psoriasis or atopic dermatitis.18
Clinical Presentation
Patients with tinea pedis may present with one of 4 possible distinct
clinical patterns: interdigital type, moccasin type, vesicular type, or acute ulcerative type (Table 3). Patients may complain of extensive pruritus or malodor; however, a significant proportion
of patients have occult disease with an asymptomatic infection.
Patients with interdigital tinea pedis, which is the most common clinical presentation, develop macerated skin in the web spaces,
most commonly in lateral 3rd and 4th interdigital web spaces (Figure 1). Contiguous skin may also be affected; however, the
dorsal foot surface remains unaffected. Patients with this pattern
of infection, if left untreated, develop macerated fissures and erythema. Warm and humid climates and hyperhidrosis are strong risk factors for this variety of presentation. T. rubrum
and E. floccosum are commonly implicated pathogens. Highly macerated cases of interdigital tinea pedis can develop bacterial secondary infection, and this presentation has been termed dermatophytosis complex.19 The name comes from the fact that although the dermatophyte infection is the inciting factor
for this disease, secondary candida and bacterial infection may arise and complicate the clinical presentation. Overgrowth of Micrococcus sedantarius, Brevibacterium epidermidis, Corynebacterium
minutissimum, Pseudomonas, or Proteus can produce dermatophytosis complex.19
Moccasin type is the second most common clinical presentation
of tinea pedis, and is typically caused by T. rubrum. Patients with the moccasin type of tinea pedis develop chronic, dry, hyperkeratotic
scale and fissures on the plantar surface of one or both feet. Collarets of scale can extend superiorly along borders
of the feet in a “moccasin†type distribution (Figure 2). Occasionally patients can develop profound hyperkeratosis and fissures. Patients with this type of infection are most often
asymptomatic and unaware that the infection is present. The moccasin type of tinea pedis may be associated with concurrent
tinea manuum infection, and so an examination of the patient’s hands is prudent. These patients may present with the so-called 2 feet-1 hand syndrome, where there is bilateral tinea
