Tinea Pedis

Interdigital tinea pedis typically presents in toe webs, while hyperkeratotic disease produces chronic scaly erythema across the plantar and lateral foot in a moccasin distribution. Vesicular or bullous disease may involve the sole. Hyperkeratotic disease is frequently associated with interdigital involvement and may extend from the toes across the plantar surface. fda+1fda[PDF] Cross Discipline Team Leader Review - FDAccjmFlexibility is warranted in applying prescribing guidelines ...

A painful, macerated, malodorous, or persistently erosive toe web should not be managed as uncomplicated dermatophyte infection alone. Refractory toe-web disease can reflect inadequate treatment, concomitant nail disease, antifungal or antibiotic resistance, or immune deficiency; reassess these branches rather than simply extending empiric topical therapy. Wolters KluwerWolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...

Examine both feet, all interdigital spaces, and toenails at the initial visit. Concurrent onychomycosis can serve as a persistent reservoir and is specifically identified as a contributor to refractory toe-web infection. Wolters KluwerWolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...

Perform a potassium hydroxide preparation from scale at the active edge or involved toe web when hyperkeratotic disease must be distinguished from inflammatory dermatoses, when bullous disease is suspected, or when prior treatment has failed. Identification of bright linear branching hyphae supports dermatophyte infection. JAMA+2JAMAA Better Potassium Hydroxide Preparation? In Vivo Diagnosis of ...JAMAA Better Potassium Hydroxide Preparation? - JAMA NetworkccjmFlexibility is warranted in applying prescribing guidelines ...

Clinical diagnosis is often used when KOH is unavailable, but a negative or unavailable bedside test should not indefinitely sustain a diagnosis of tinea in chronic disease. In chronic or recurrent dermatophytosis and when antifungal resistance is suspected, order fungal culture; culture and serial cultures may also help establish mycologic cure in selected patients. BMJ+1BMJDermatophyte infections - Symptoms, diagnosis and treatmentccjmTinea incognito | Cleveland Clinic Journal of medicine

If a topical corticosteroid has altered lesion morphology, consider tinea incognito. Look for residual scaly erythematous edges, obtain KOH, and culture chronic, recurrent, or potentially resistant disease. Polymerase chain reaction and matrix-assisted laser desorption ionization-time-of-flight are emerging higher-sensitivity approaches where available. ccjmccjmTinea incognito | Cleveland Clinic Journal of medicine

For nonextensive tinea pedis, use terbinafine 1% cream or gel twice daily for 1-2 weeks. Miconazole is an alternative topical regimen applied for 3-4 weeks. A broad evidence base supports topical antifungals over placebo, and terbinafine or naftifine may provide slightly higher cure rates than azoles. Wolters Kluwer+1Wolters KluwerManagement of tinea corporis, tinea cruris, and tinea... : Indian Dermatology Online JournalWHO[PDF] Guidelines on the treatment of skin and oral HIV-associated ... - IRIS

Apply cream or powder 1-2 cm beyond visible disease and continue for 1 week after apparent clinical resolution. For hyperkeratotic plantar disease, a 2-3 week or 4-week course may be needed; the longer duration reflects the barrier imposed by thick keratinized skin. Wolters Kluwer+1Wolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...ccjmFlexibility is warranted in applying prescribing guidelines ...

Luliconazole 1% is an FDA-approved topical option for interdigital tinea pedis. In pivotal trials, participants applied it once daily for 14 days to the entire forefoot, all interdigital spaces, and approximately 2.5 cm of surrounding skin; outcomes were assessed 4 weeks after treatment. dailymed nlm nihdailymed nlm nihThese highlights do not include all the information needed to use Luliconazole Cream safely and effectively. See full prescribing information for Luliconazole Cream. Luliconazole cream, for topical useInitial U.S. Approval: 2013

At follow-up, determine whether the initial regimen reached all involved toe webs and plantar surfaces and whether treatment continued beyond visible resolution. For hyperkeratotic disease, an apparent early failure may simply represent insufficient duration because topical penetration is limited by keratinization. Wolters Kluwer+1Wolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...ccjmFlexibility is warranted in applying prescribing guidelines ...

If disease is recurrent or persists after an adequate course, perform fungal culture and inspect for onychomycosis. Nail involvement, immune deficiency, and antifungal or antibiotic resistance are recognized contributors to refractory toe-web infection. Wolters Kluwer+1Wolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...ccjmTinea incognito | Cleveland Clinic Journal of medicine

When toe webs are macerated or otherwise clinically concerning for bacterial involvement, evaluate for mixed infection rather than treating dermatophytes in isolation. Dermatophyte-associated barrier disruption can precede interdigital toe-web infection, and bacterial cultures from interdigital spaces in patients with tinea pedis have recovered potentially pathogenic organisms, commonly group A beta-hemolytic streptococci. Wolters Kluwer+1Wolters KluwerToe Web Infections, the Microbiome, and Toe Web Psoriasis:...ccjmRecurrent Cellulitis: Who is at Risk and How Effective is Antibiotic P | IJGM | Dove Medical Press