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Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Tinea pedis: an updated review. Drugs Context 2023; 12:2023-5-1. [PMID: 37415917 PMCID: PMC10321471 DOI: 10.7573/dic.2023-5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis. Methods A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years. Results Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients. Conclusion Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong Medical Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
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Zareshahrabadi Z, Totonchi A, Rezaei-Matehkolaei A, Ilkit M, Ghahartars M, Arastehfar A, Motamedi M, Nouraei H, Sharifi Lari M, Mohammadi T, Zomorodian K. Molecular identification and antifungal susceptibility among clinical isolates of dermatophytes in Shiraz, Iran (2017-2019). Mycoses 2020; 64:385-393. [PMID: 33295089 DOI: 10.1111/myc.13226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
Dermatophytosis is a common superficial mycotic infection affecting individual's quality of life worldwide. The present study aimed to perform species-level identification and evaluate the antifungal susceptibility patterns of dermatophytes isolated in Shiraz, Iran. This cross-sectional study was conducted on clinical samples collected during 2017-2019 from 307 patients suspected of having dermatophytosis. The isolates were identified by direct microscopy, culture and internal transcribed spacer ribosomal DNA sequencing, and their antifungal susceptibility patterns were determined by the microdilution method. Among 307 patients, dermatophytosis was diagnosed by microscopy in 190 (61.8%) subjects and confirmed in 130 (42.3%) cases by both microscopy and culture. It was found out tinea pedis was the most common clinical manifestation, and Trichophyton mentagrophytes was the most prevalent species (28.4%), followed by T tonsurans (23.8%), Microsporum canis (11.5%), T interdigitale (10%), T verrucosum (6.9%), T rubrum (6.9%), T benhamiae (4.6%), T violaceum (3%), T simii (3%), Epidermophyton floccosum (0.7%) and M ferrugineum (0.7%). Moreover, it was revealed that luliconazole with a geometric mean (GM) minimum inhibitory concentration (MIC) of 0.03 μg ml-1 was the most effective agent against all tested isolates. Regardless of species, 30% of isolates responded to high MICs of griseofulvin (MIC90 > 2 μg ml-1 ). The increasing prevalence of nonindigenous species of T simii, T benhamiae and M ferrugineum in Shiraz, Iran, was a notable finding. In addition, infections due to zoophilic species showed an increasing trend. These epidemiological data, along with antifungal susceptibility patterns, may have implications for clinical decision-making and successful treatment.
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Affiliation(s)
- Zahra Zareshahrabadi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Totonchi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University Çukurova, Adana, Turkey
| | - Mehdi Ghahartars
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Marjan Motamedi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hasti Nouraei
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Sharifi Lari
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tooba Mohammadi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Antifungal resistance in dermatophytes: Recent trends and therapeutic implications. Fungal Genet Biol 2019; 132:103255. [PMID: 31330295 DOI: 10.1016/j.fgb.2019.103255] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Dermatophytoses or tinea refers to superficial fungal infection of keratinized tissues. Although generally considered easy to treat, recalcitrant infections, presenting as extensive and difficult to treat tinea corporis and cruris, are on the rise in some parts of the world. The situation demands an understanding of the pharmacokinetic and pharmacodynamic properties of the available antifungals against dermatophytes and the possible contribution of drug resistance and other factors to the present scenario. In this review, we provide the readers a comprehensive account of the available literature on in-vitro and in-vivo resistance to clinically used antifungals among dermatophytes. We have also added, in brief, the relevant skin pharmacokinetics of important systemic drugs. The established and postulated mechanisms of drug resistance are discussed and aspects on lack of in vivo correlation of in vitro resistance are presented. Finally, the lacunae in our existing knowledge on the topic and the arenas for future research are highlighted.
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Sakka N, Shemer A, Barzilai A, Farhi R, Daniel R. Occult tinea pedis in an Israeli population and predisposing factors for the acquisition of the disease. Int J Dermatol 2014; 54:146-9. [PMID: 24739076 DOI: 10.1111/ijd.12506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tinea pedis is a commonly encountered dermatophytic infection with a clinical prevalence of 15-25%. Limited studies have evaluated the prevalence of occult tinea pedis. OBJECTIVES The aims of this study were to evaluate the prevalence of occult tinea pedis in asymptomatic subjects with feet that appeared healthy and to identify possible related risk factors. METHODS A prospective study of 221 asymptomatic subjects with apparently normal feet was conducted. All subjects completed a questionnaire covering anamnestic details (personal and family histories of tinea pedis, preferred footwear) and were examined for foot odor and the clinical presence of tinea pedis and onychomycosis. Samples were taken from the foot for direct microscopic examination and culture. RESULTS Among the 221 patients, 31 (14.0%) were positive for occult tinea pedis. Positive cultures from both the anterior and posterior aspects of the foot were obtained in 22 patients. The most common pathogen isolated was Trichophyton rubrum. Strong correlations emerged between occult tinea pedis and characteristics such as male gender, foot odor, previous personal and family histories of tinea pedis, and clinical and mycological evidence of onychomycosis. No significant associations were found between occult tinea pedis and age or preferred footwear. CONCLUSIONS The prevalence of occult tinea pedis is similar to that of clinical tinea pedis. This may imply that patients with subclinical infection carry a risk for transmitting disease similar to that of clinical carriers. This is of great importance in the prevention and management of the disease as high-risk asymptomatic carriers can be identified.
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Affiliation(s)
- Nicole Sakka
- Department of Dermatology and Dermatomycology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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