Athlete’s Foot symptoms, causes and treatments

Athlete’s Foot symptoms, causes, risk factors, recognition and treatments.  This athlete’s food guide is for anyone who has this issue or someone who wants to increase their knowledge about it.  It is written for people around the world but trainer.ae would like people in the UAE to be able to learn from it; this includes athlete foot victims in Duba, Abu Dhabi, Sharja, Ajman, RAK and rest of the UAE.

Introduction: what is athlete’s foot?
What causes athlete’s foot?
Who gets athlete’s foot?
What are the symptoms of athlete’s foot?
What does athlete’s foot look like?
How is athlete’s foot diagnosed?
What other conditions could be confused with athlete’s foot?
How can one prevent athlete’s foot?
How is athlete’s foot treated?
Is athlete’s foot a serious condition?
Introduction: what is athlete’s foot?

You don’t have to be an athlete to get athlete’s foot. In fact, anyone with sweaty feet can acquire this common superficial fungal infection. Athlete’s foot is a rash that occurs on the soles of the feet and the skin between the toes (Figure 1). It is the most common fungal infection in the United States and is estimated to affect up to 70% of the world’s population at some time in their life. The medical term for athlete’s foot is tinea pedis.

What causes athlete’s foot?

Athlete’s foot is caused by fungi known as dermatophytes, a term derived from the Greek, meaning “skin plants.” Dermatophytes are filamentous fungi that grow on humans, animals, or in the soil. These fungi live on keratin, a protein found in the outermost layer of human skin, as well as in hair and nails. The fungi are not able to penetrate beyond the outer layer of the skin or cause internal disease.

The fungal species that commonly cause athlete’s foot are Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans (in the rare cases that occur in children), and Epidermophyton floccosum. Less commonly, Scytalidium molds and Candida yeasts may cause athlete’s foot. The relative frequency of these fungal pathogens varies from one part of the world to another. For example, whereas T. rubrum caused 63.3% of cases of athlete’s foot in a Japanese survey, it was responsible for only 17% of cases in Algeria, where Candida yeasts caused 20% of cases.

Who gets athlete’s foot?

Athlete’s foot is common worldwide in adults of both sexes and all races. It is uncommon in children, occurring in only 0.15% of children aged six-14 in a Turkish study. A small study comparing professional and college soccer players to non-athletes did show that athlete’s foot was significantly more common in the soccer players, but this condition is by no means exclusive to athletes. It is also common in military personnel, boarding school students, and farm workers.

Athlete’s foot is a contagious disease. It may be acquired by using locker rooms and communal showers that are contaminated with the causative fungi. It is more common in areas of high heat and humidity and in people who wear shoes. In fact, athlete’s foot is quite rare in cultures where people go barefoot. The fungi that cause athlete’s foot require moisture in order to grow, so sweaty feet that spend 12 hours a day shut inside shoes provide the perfect environment.

The fungi that cause athlete’s foot also may cause jock itch (tinea cruris), toenail infection (onychomycosis), and fungal infection of the hand (tinea manuum). Having any of these other fungal infections is a risk factor for athlete’s foot. In a study of 1181 patients in Poland with toenail fungus, 33.8% also had athlete’s foot. Two thirds of these had the interdigital type of athlete’s foot, which affects the skin between the toes. This is a higher frequency of athlete’s foot than would be expected in the general population.

Interestingly, some people seem to be much more susceptible to athlete’s foot than others, despite having an otherwise normal immune system. It is possible that subtle differences in a type of immunity known as the innate immune system may make some people more resistant to athlete’s foot. Studies have shown that a protein with antimicrobial properties, known as beta-defensin-2, is elevated in skin from people with athlete’s foot, suggesting that this protein may play a role in host defense against fungus.

To summarize, risk factors for athlete’s foot include:

living in a warm humid climate (dubai is warm and gets humid)
wearing air-tight shoes
using locker rooms and public showers
having another fungal infection such as jock itch, fungal toenails, or fungal infection of the hand
immunesuppression diabetes mellitus
What are the symptoms of athlete’s foot?

Athlete’s foot may be itchy, painful, or have no symptoms at all. When the skin is chronically moist due to air-tight footwear, there may also be an unpleasant odor. In severe or inflammatory cases of athlete’s foot — or when a bacterial infection is also present — the skin may be very sore and uncomfortable.

What does athlete’s foot look like?

There are three main types of athlete’s foot. Each type has a different appearance and symptoms, though any two or even all three types may occur together:

1. Interdigital athlete’s foot is an infection of the web spaces between the toes, particularly between the 4th and 5th toes. The skin appears moist and waterlogged  and is often itchy. This is the most common kind of athlete’s foot.

2. Moccasin type athlete’s foot is a rash involving the bottoms of the feet, the heels and the sides of the feet. As its name suggests, this type of athlete’s foot involves the area of the foot that would be covered by a moccasin, although it may extend onto the top of the foot and in severe cases may cover the entire foot. It has a dry scaly (flaky) appearance. The skin may be red or flesh-colored and the scale may range from white to silver. This type of athlete’s foot is rarely itchy or uncomfortable.

A clue to the presence of athlete’s foot is the presence of co-existing fungal toenail infection. The toenails may appear thickened and discolored, and have crumbly material underneath the nail, which is partially separated from the underlying skin.

Some people with athlete’s foot have a co-existing fungal infection on one of their hands, in the so-called “Two feet- one hand tinea” syndrome. Thus, it is important to examine the hands in people with athlete’s foot, and to treat them as well, if they appear red and scaly.

How is athlete’s foot diagnosed?

When someone has a red, scaly, itchy rash on the soles of the feet or between the toes, the diagnosis of athlete’s foot is usually straightforward. Nonetheless, there are several other conditions that can appear similar to athlete’s foot, so physicians may need to confirm the diagnosis with one of the following diagnostic tests:

Potassium hydroxide preparation: In this test, the physician uses a sharp blade or glass slide to scrape off dead skin cells from the edge of the rash. The dead skin cells are collected onto a microscope slide, treated with a solution of potassium hydroxide and heated to digest the cells, and then examined under a microscope. Sometimes, a dye is added to the potassium hydroxide solution to facilitate visualization of the fungal elements. The physician examines the slide, looking for branching filaments of the fungus. This is the most rapid and inexpensive test to identify dermatophyte fungi, although it occasionally gives false negative results when an individual has already partially treated their athlete’s foot and few fungal cells are still present.
Fungal culture: The physician scrapes dead skin cells from the edge of the rash and sends them to a microbiology laboratory. There, the material is applied to fungal culture medium. By the appearance of the fungal colonies that grow and their growth characteristics, it is possible not only to show that a fungus was present, but also determine the species. However, this method takes two to three weeks to give results and also frequently gives false negative results. Furthermore, it is not usually necessary to know the exact species in order to treat athlete’s foot.
Skin biopsy: When a case of athlete’s foot looks very similar to other skin diseases and a potassium hydroxide preparation is negative or inconclusive, physicians will sometimes take a small sample of skin for pathologic examination. Under local anesthesia, a small plug of skin called a punch biopsy is removed and fixed in formalin. Pathologists examine the skin after slicing it into thin sections and staining it with dyes that highlight fungal elements. This method is most expensive (and slightly uncomfortable for the patient), but it does usually give definitive diagnostic results.

What other conditions could be confused with athlete’s foot?

Athlete’s foot may be confused with several skin conditions, but they can usually be distinguished based on the appearance of the rash or diagnostic testing:

Dyshidrotic eczema: this itchy rash occurs on the palms and soles, often in people who have a history of atopic dermatitis (eczema). It appears as tiny water blisters that look like tapioca pearls. Unlike athlete’s foot, it responds to corticosteroid creams, rather than to antifungal preparations.
Contact dermatitis: this rash occurs as an irritant or allergic reaction to a chemical or other product that has contacted the skin, for example rubber products present in shoes. Unlike athlete’s foot, it usually affects the tops of the feet more than the soles and it responds to corticosteroid creams.
Psoriasis: this rash may affect the palms and soles with red scaly skin or pustules, but it usually will also be found on the knees, elbows, buttocks, or scalp — allowing distinction from athlete’s foot.
Erythrasma/pitted keratolysis: These common skin infections with Corynebacteria and Micrococcus bacteria may appear as a red scaly rash or tiny pits in the soles of the feet. They respond to topical antibiotic preparations rather than to antifungals.

Dry skin: Especially in the winter, people may have dry, scaly skin on the soles of the feet in the absence of any fungal infection.

Athlete’s foot can be distinguished from each of the conditions listed above by doing a skin scraping and potassium hydroxide preparation (Figure 9) or fungal culture. These tests would be expected to show evidence of fungi in athlete’s foot and be negative in all the other diseases.

How can one prevent athlete’s foot?

The best way to prevent athlete’s foot is to keep the feet clean and dry and avoid exposure to athlete’s foot fungus. The following measures may be helpful:

Carefully drying the feet and spaces between the toes after bathing
Applying a drying powder to the feet or shoes daily
Changing socks frequently if they become damp
Avoiding occlusive (non-breathable) footwear
Wearing sandals or other open footwear when possible
Avoiding walking barefoot in locker rooms and communal showers where fungal spores may be found
Avoiding sharing socks, towels, or shoes with others

How is athlete’s foot treated?

Athlete’s foot can usually be cured with topical antifungal creams, gels, sprays, or powders, several of which are available over-the-counter (OTC). These products should be used twice daily until the rash has resolved (usually two to four weeks) and then used weekly in order to prevent recurrence of the infection. If you suspect you have athlete’s foot, but find that it does not improve as expected with one of the following medications, it is important to see a doctor to confirm the diagnosis and obtain appropriate treatment.

The following topical medicines are effective for athlete’s foot:

Clotrimazole 1% cream (OTC)
Miconazole nitrate 2% cream, spray, or powder (OTC)
Tolnaftate 1% spray (OTC)
Terbinafine 1% cream (OTC)
Ciclopiroxolamine 1% cream or gel
Naftifine 1% cream or gel
Oxiconazole 1% cream
Sertaconazole nitrate 2% cream
Butenafine 1% cream
Econazole nitrate 1% cream
Ketoconazole 2% cream

Certain types of athlete’s foot may be more difficult to treat, including the moccasin and inflammatory types. In cases that do not respond to topical antifungal preparations, oral antifungal tablets or capsules are required. Physicians prescribe a particular medication and dose based on the patient’s age, weight, and any other medical conditions they may have.

The following oral medicines are effective for athlete’s foot:

Terbinafine 250 mg daily for two to six weeks
Itraconazole 200 – 400 mg daily for two to four weeks
Fluconazole 150 mg weekly for up to four weeks
Griseofulvin microsize five to seven milligrams per kilogram of body weight (up to 500 mg) daily for six to twelve weeks

Adjunctive treatment with drying powders, drying agents, and creams that soften the thick layers of skin on the feet can also be helpful:

Drying powders: these contain talc or cornstarch and may contain an antifungal medicine as well. They are used daily on the feet and in the shoes to keep the feet dry and kill fungus.
Keratolytic agents: Urea 10% or 20% cream and ammonium lactate 12% cream are potent moisturizers that help remove thick layers of dead skin on the soles of the feet, allowing the antifungal medicines to penetrate better and kill the fungus faster.
Aluminum acetate (Domeboro or Burow’s solution): in cases of inflammatory (blistering) athlete’s foot, the feet can be soaked once or twice daily for five minutes in a solution made by dissolving aluminum acetate in water at a dilution of 1:10-1:40. This will help dry up the blister fluid and speed healing.
Aluminum chloride 12% or 20%: this anti-perspirant solution may be applied to the feet at bedtime for several weeks in order to decrease daytime sweating and help keep the feet dry. Decreased sweating may reduce the risk of recurrence of athlete’s foot.

Is athlete’s foot a serious condition?

Since the fungi that cause athlete’s foot live on keratin protein found in the outer layer of the skin, the hair, and the nails, they cannot invade deeper tissues and cause serious illness. Nonetheless, athlete’s foot can be very uncomfortable and unsightly, prompting affected individuals to seek medical treatment. Since athlete’s foot is very common and quite contagious, it is important to treat from a public health perspective.

It is especially important to treat athlete’s foot in people who have diabetes or are immunosuppressed, because they run an increased risk of developing a secondary bacterial infection from the open cracked skin of athlete’s foot. Another reason for treating athlete’s foot is that fungus growing on the feet can spread to other parts of the body, causing jock itch, ringworm, or fungal toenails, which may be harder to treat than the original athlete’s foot.

What’s next?

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