ATHLETE FOOT

Athlete's foot, also known as tinea pedi and ringworm of the foot, is a fungal infection that affects the upper layer of the skin of the foot, especially when it is warm, moist and irritated. Athlete's foot is a form of ringworm. The fungus that causes athlete's foot is called Trichophyton, and is commonly found on floors and in clothing. Athlete's foot fungus will not infect the skin ifconditions are not right - it requires a warm and moist environment. Because of this, only about 0.75% of people who regularly walk about barefoot are affected. Athlete's foot typically develops between our toes and occasionally on other parts of our feet. It usually causes burning, stinging and/or itching. It is the most common type of fungal infection. Although it is contagious, athlete's foot is usually easily treated with OTC (over-the-counter, no prescription required) medication. According to Medilexicon's medical dictionary, Tinea Pedis is:

"Dermatophytosis of the feet, especially of the skin between the toes, caused by one of the dermatophytes, usually a species of Trichophyton or Epidermophyton; the disease consists of small vesicles, fissures, scaling, maceration, and eroded areas between the toes and on the plantar surface of the foot; other skin areas may be involved.

What are the signs and symptoms of athlete's foot?

A symptom is something we feel and describe to other people, while a sign can be seen or detected by others. An example of a symptom is an itch, while a sign could be a rash or skin redness. The skin on the foot, especially between the toes becomes Itchy - there is also a sensation of stinging or burning. The skin may also become:

dry flaky red scaly

In severe cases of athlete's foot, the toes, toenails, soles and sides of the feet may be affected

The skin may also crack, there may be oozing or crusting blisters, and swelling. The sole and the side of the foot may develop scalingpatterns. In severe cases there may be large, opencracks which reveal raw tissue. This can be painful and exposes the patient to infections. If left untreated, there is a risk that the infection spreads from one toe to the next, and then the next, a rash may develop on the sides and the bottom of the feet. Onychomycosis - the toenails may become dry and crumbly. If the patient scratches the affected area and touches other parts of his/her body, the infection can spread. Doctors say it is important to treat athlete's foot as soon as symptoms appear. After touching the affected area, remember to wash your hands thoroughly with soap and warm water. Infection can spread to the hands - this is called tinea manuum. Patients who do not wash their hands immediately after touching the affected area in their foot/feet are at higher risk. Tinea manuum is a rare complication of athlete's foot.

What are the causes of athlete's foot?

The athlete foot fungus,Trichophyton, is related to other fungi that cause infections in human skin, hair and nails, examples include jock itch and ringworm. These infections are caused by a group of fungi called dermatophytes. Dermatophytes are parasitic; they feed off other organisms to survive. These fungi exist harmlessly on human skin. However, as long as the skin is dry and clean, their reproduction is limited. Under damp and warm conditions they multiply rapidly. Thick, tight shoes are more likely to trigger athlete's foot because they squeeze the toes together, creating ideal conditions for the fungus to thrive. Experts say that plastic shoes, which warm and moisten feet the most, are more likely to bring on athlete's foot than those made from other materials, such as leather or canvass. If your socks are damp and your feet are warm, there is a greater risk of developing athlete's foot. Athlete's foot can be spread through direct and indirect contact:

Direct contact - this means skin-to-skin contact, as may occur when an uninfected person touches the infected area of somebody with athlete's foot.

Indirect contact - the fungi can infect people via contaminated surfaces, clothing, socks, shoes, bed sheets and towels. Athlete's foot commonly spreads around swimming pools and communal showers - these places are general humid and warm. People with weakened immune systems are more susceptible to developing athlete's foot.

How is athlete's foot diagnosed?

If a person has athlete's foot, the hallmark signs and symptoms will usually make it pretty evident. Sometimes, a doctor may want to determine whether the patient might have some other condition, such as dermatitis, psoriasis or a low-grade skin infection. The doctor may scrape some of the skin and check the samples under a microscope (potassium hydroxide test). If fungi are detected, then an antifungal medication will be recommended. If it is not a fungus, the doctor may re-examine the affected area with a Wood's light to determine whether there is a reddish fluorescence caused by a bacterium callederythrasma. If both the tests come back negative, the skin sample may be sent to the laboratory for further analysis.

What are the treatment options for athlete's foot?

In the majority of cases, athlete's foot symptoms are mild and the patient does not need to see a doctor. OTC (over-the-counter, no prescription required) medications can be bought at pharmacies which are effective in clearing up the infection. According to the National Health Service, UK, athlete's foot can be treated effectively with a combination of self-care techniques and medication. In severe cases, your doctor may prescribe a more powerful antifungal medication, which is usually taken orally (swallowed). Things you can do yourself (self care):

Wash your feet often with soap and water Make sure your feet are completely dry after washing them, especially between your toes Wear cotton socks (make sure they are clean!!) In order to keep your feet dry, change your shoes and socks often Wash your towels regularly, do not share them Medications for athlete's foot These are known as antifungal medications. They kill the fungus that is causing your symptoms. Antifungal medications are available as:

tablets powders liquids sprays creams Most topical medications can be bought OTC at your local pharmacy. Topical means it is applied directly onto the skin. Your pharmacist may recommend one of the following antifungal medications:

clotrimazole econazole ketoconazole miconazole terbinafine sulconazole These oral medications may be prescribed by your doctor, either because your symptoms are severe, or perhaps the topical medicines did not work:

griseofulvin itraconazole terbinafine - this medication can cause liver inflammation in susceptible patients (rare) If you are on other medications tell your doctor. Antacids may interfere with the absorption of oral antifungals. Oral antifungals may also affect how anticoagulant drug warfarin works. Elderly patients and young children should not be given some types of antifungals. Check with your pharmacist, doctor, nurse or read the leaflet that comes with the medication carefully. Dosages may be different for children. If you are pregnant, or planning to have children, check with your doctor. Some antifungals should not be taken during pregnancy, while others may interfere with the male and female reproductive systems. How to apply topical medications

Make sure your skin is clean and dry before you start.

Apply the medication directly onto the affected area, as well as some surrounding area of normal skin. It is important to apply the medicine to the surrounding area. Not all infected skin has symptoms of infection.

Make sure you wash your hands before you start, and after you have finished.

Follow the instructions on the leaflet regarding how often you apply the medication and how long the treatment lasts. Not all antifungals are the same.

You usually have to keep applying the medication after signs and symptoms have gone. Although the rash goes away rapidly, that does not always mean that you are infection-free.

Hydrocortisone
If the skin is very sore and there is a lot of swelling, the doctor may recommend using hydrocortisone. Low-dose hydrocortisone medications can be bought OTC - higher doses will require a doctor's prescription. Hydrocortisone is effective for relieving the symptoms of itching and irritation. Make sure you follow the instructions on the leaflet carefully. Do not use hydrocortisone for more than seven days. Ask your doctor about hydrocortisone if you are breastfeeding or pregnant. Your doctor may recommend that you use medication continuously if your athlete's foot keeps coming back.

What are the complications of athlete's foot?

Although athlete's foot symptoms are mostly mild and complications are rare, experts say it is best to treat it promptly. Early treatment significantly reduces the risk of complications. Fungal nail infection - untreated athlete's foot can spread to your toenails (onychomycosis). The nail becomes thick, opaque (whitish) and crumbly. There may be pain and inflammation in the skin under the nail. Untreated toenail infection may eventually lead to more pain and problems wearing shoes, or even walking about. Bacterial infection - in severe cases of athlete's foot, the skin may crack open, exposing raw tissue to bacterial infection (rare). Cellulitis is a bacterial infection deep down in the skin. Skin, fat and soft tissue may be affected. Untreated cellulitis can lead to serious complications, such as septicemia (blood poisoning) orbone infection. Although a very rare complication of athlete's foot, cellulitis should be treated immediately with antibiotics.

How to prevent athlete's foot

The secret to minimizing the risk of developing athlete's foot is to always have clean and dry feet, shoes and socks. Experts advise the following:

Wash your feet twice a day with water and soap. Make sure you clean between your toes each time Keep your feet dry. If it helps, apply (antifungal) talcum powder to your feet. Walk around barefoot at home as much as you can. If you have diabetes, do not walk around barefoot, but let your feet "breathe" (air) as much as you can As soon as you have finished doing sports or exercise, take your shoes off Wear loose-fitting, well ventilated shoes, especially during the warmer months. The best material for shoes are leather or canvass. Wear sandals when you can Make sure your feet are dry before putting your socks, stockings or tights on. Wear socks made from material that draws moisture away from your feet, such as cotton, silk or wool When walking around public swimming pools and communal changing rooms and shower areas wear pool slippers Change the shoes you wear regularly, so that your footwear is relatively dry. Shoes need time to dry out between wearings Do not share footwear Wash your sheets and towels regularly If your pet has hair loss, this could be a sign of athlete's foot - take it to the vet. Humans can catch athlete's foot from their pets. If your child has athlete's foot he/she should go to school, but the teacher should be told so that appropriate measures are taken before/during P.E. classes. The child should not walk barefoot while at school.