- Author: Courtney M Robbins, MD; Chief Editor: Dirk M Elston, MD more...
Tinea pedis has afflicted humanity for centuries, so it is perhaps surprising that the condition was not described until Pellizzari did so in 1888. The first report of tinea pedis was in 1908 by Whitfield, who, with Sabouraud, believed that tinea pedis was a very rare infection caused by the same organisms that produce tinea capitis.
Tinea pedis is the term used for a dermatophyte infection of the soles of the feet and the interdigital spaces. Tinea pedis is most commonly caused by Trichophyton rubrum, a dermatophyte initially endemic only to a small region of Southeast Asia and in parts of Africa and Australia. Interestingly, tinea pedis was not noted in these areas then, possibly because these populations did not wear occlusive footwear. The colonization of the T rubrum –endemic regions by European nations helped to spread the fungus throughout Europe. Wars with accompanying mass movements of troops and refugees, the general increase in available means of travel, and the rise in the use of occlusive footwear have all combined to make T rubrum the world's most prevalent dermatophyte.
The first reported case of tinea pedis in the United States was noted in Birmingham, Alabama, in the 1920s. World War I troops returning from battle may have transported T rubrum to the United States.
T rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum most commonly cause tinea pedis, with T rubrum being the most common cause worldwide. Trichophyton tonsurans has also been implicated in children. Nondermatophyte causes include Scytalidium dimidiatum, Scytalidium hyalinum, and, rarely, Candida species.
Using enzymes called keratinases, dermatophyte fungi invade the superficial keratin of the skin, and the infection remains limited to this layer. Dermatophyte cell walls also contain mannans, which can inhibit the body's immune response. T rubrum in particular contains mannans that may reduce keratinocyte proliferation, resulting in a decreased rate of sloughing and a chronic state of infection.
Temperature and serum factors, such as beta globulins and ferritin, appear to have a growth-inhibitory effect on dermatophytes; however, this pathophysiology is not completely understood. Sebum also is inhibitory, thus partly explaining the propensity for dermatophyte infection of the feet, which have no sebaceous glands. Host factors such as breaks in the skin and maceration of the skin may aid in dermatophyte invasion. The cutaneous presentation of tinea pedis is also dependent on the host's immune system and the infecting dermatophyte.
Tinea pedis is thought to be the world's most common dermatophytosis. Reportedly, 70% of the population will be infected with tinea pedis at some time.
Tinea pedis has no predilection for any racial or ethnic group.
Tinea pedis more commonly affects males compared with females.
The prevalence of tinea pedis increases with age. Most cases occur after puberty. Childhood tinea pedis is rare.
Pellizzari C. Recherche sur Trichophyton tonsurans. G Ital Mal Veneree. 1888. 29:8.
Lopez-Martinez R, Manzano-Gayosso P, Hernandez-Hernandez F, Bazan-Mora E, Mendez-Tovar LJ. Dynamics of dermatophytosis frequency in Mexico: an analysis of 2084 cases. Med Mycol. 2009 Nov 3. [Medline].
Zhan P, Ge YP, Lu XL, She XD, Li ZH, Liu WD. A case-control analysis and laboratory study of the two feet-one hand syndrome in two dermatology hospitals in China. Clin Exp Dermatol. 2009 Oct 23. [Medline].
Leyden JJ. Progression of interdigital infections from simplex to complex. J Am Acad Dermatol. 1993 May. 28(5 Pt 1):S7-S11. [Medline].
Gentles JC. The isolation of dermatophytes from the floors of communal bathing places. J Clin Pathol. 1956 Nov. 9(4):374-7. [Medline].
Gentles JC, Evans EG. Foot infections in swimming baths. Br Med J. 1973 Aug 4. 3(5874):260-2. [Medline].
Parish LC, Parish JL, Routh HB, Fleischer AB Jr, Avakian EV, Plaum S, et al. A randomized, double-blind, vehicle-controlled efficacy and safety study of naftifine 2% cream in the treatment of tinea pedis. J Drugs Dermatol. 2011 Nov 1. 10(11):1282-8. [Medline].
Weinberg JM, Koestenblatt EK. Treatment of interdigital tinea pedis: once-daily therapy with sertaconazole nitrate. J Drugs Dermatol. 2011 Oct 1. 10(10):1135-40. [Medline].
Carrillo-Muñoz AJ, Tur-Tur C, Cárdenes DC, Estivill D, Giusiano G. Sertaconazole nitrate shows fungicidal and fungistatic activities against Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, causative agents of tinea pedis. Antimicrob Agents Chemother. 2011 Sep. 55(9):4420-1. [Medline]. [Full Text].
Luzu (luliconazole topical cream 1%). [package insert]. Valeant Pharmaceuticals. 2013.
Gupta AK, Cvetkovic D, Abramovits W, Vincent KD. LUZU (luliconazole) 1% cream. Skinmed. 2014 Mar-Apr. 12(2):90-3. [Medline].
Stein Gold LF, Parish LC, Vlahovic T, Plaum S, Kircik L, Fleischer AB Jr, et al. Efficacy and safety of naftifine HCl Gel 2% in the treatment of interdigital and moccasin type tinea pedis: pooled results from two multicenter, randomized, double-blind, vehicle-controlled trials. J Drugs Dermatol. 2013 Aug. 12(8):911-8. [Medline].
Kircik LH, Onumah N. Use of naftifine hydrochloride 2% cream and 39% urea cream in the treatment of tinea pedis complicated by hyperkeratosis. J Drugs Dermatol. 2014 Feb. 13(2):162-5. [Medline].
Gupta AK, Baran R, Summerbell R. Onychomycosis: strategies to improve efficacy and reduce recurrence. J Eur Acad Dermatol Venereol. 2002 Nov. 16(6):579-86. [Medline].
Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res. 2011 Dec 4. 4:26. [Medline]. [Full Text].
Elewski BE, Vlahovic TC. Econazole nitrate foam 1% for the treatment of tinea pedis: results from two double-blind, vehicle-controlled, phase 3 clinical trials. J Drugs Dermatol. 2014 Jul 1. 13(7):803-8. [Medline].
Savin R, De Villez RL, Elewski B, et al. One-week therapy with twice-daily butenafine 1% cream versus vehicle in the treatment of tinea pedis: a multicenter, double-blind trial. J Am Acad Dermatol. 1997 Feb. 36(2 Pt 1):S15-9. [Medline].
Gul U, Cakmak SK, Ozel S, Bingol P, Kaya K. Skin disorders in patients with hemiplegia and papaplegia. J Rehabil Med. 2009 Jul. 41(8):681-3. [Medline].
Bristow IR, Spruce MC. Fungal foot infection, cellulitis and diabetes: a review. Diabet Med. 2009 May. 26(5):548-51. [Medline].
Bolognia JL, Jorizzo JL, Rapini RP, et al. Dermatology. New York, NY: Mosby; 2003. 1174-85.
Weidman FD. Laboratory aspects of epidermophytosis. Arch Dermatol. 1927. 15:415-50.
Chen S, Ran Y, Dai Y, Lama J, Hu W, Zhang C. Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis. Pediatr Dermatol. 2015 Oct 8. [Medline].