With an objective to evaluate the sensitivity and specificity of KOH smear and fungal culture in diagnoses of tinea pedis, Levitt et al., (2010) performed a pool analysis of data from five similarly conducted antifungal trials. They obtained data from 460 patients with tinea pedis and fungal cultures analyzed 6 weeks after study initiation to determine KOH specificity and sensitivity. They observed that KOH smear and fungal cultures to be complementary diagnostic tests for tinea pedis.
Tinea pedis and onchomycosis leads to foot ulcers to diabetic patients making them more susceptible to bacterial infections which may lead to ultimate amputation of the limb. In an effort to identify effective evidence based treatment for tinea pedis in people with diabetes, Matricciani et al., (2011) conducted a literature search on four electronic databases to review what evidence is there for treatment interventions for diabetic adults with tinea pedis. Their results indicated that oral terbinafine is as safe and effective as itraconazole therapy for the treatment of onychomycosis in diabetic patients; however, they recommended further investigative research on other treatment methods for tinea pedis in diabetic patients.
Semel and Goldin (1996) conducted a study to determine the frequency of patients with lower extremity cellulitis but no trauma, peripheral vascular disease or chronic open ulcers have interdigital athlete’s foot and whether cultures from the interdigital spaces would yield potentially pathogenic bacteria. From their study, of 22 patients, there were 24 episodes of lower exteremity cellulitis that met the inclusion criteria, and athlete’s foot was present in 20 of these episodes. However, many of these patients were not aware that they actually had the athlete’s foot disease although some reported to having had athlete’s foot previously. Cultures were conducted from the patients with cellulitis and athlete’s foot to yield 34 species of pathogenic microorganisms with gram positive organisms being isolated in all 20 episodes where athlete’s foot was present. Specifically, the β-hemolytic streptococci was isolated in 17 of 20 episodes with group A, B, C and G streptococci being isolated in 4, 3, 1 and 9 episodes respectively. Nine of 20 episodes had Staphylococcus aureus isolated while 7 of 20 episodes had gram negative rods. Cellulitis of the lower extremities is caused by the entry of microorganisms through an open ulcer and from this study; results suggested that athlete’s foot is a common entry portal to these kinds of microorganisms. Therefore, all cases of lower extremity cellulitis not caused as a result of trauma, ischemia or open ulcers should be investigated for athlete’s foot and bacterial cultures of the ipsilateral interspaces affected by athlete’s foot may reveal the microbial etiology of the cellulitis, while therapy towards the β-hemolytic streptococci should be adequate in most cases as well as frequent examination of athlete’s foot. A similar study by Hasan et al., (2004) also supported that cellulitis can get complicated out of tinea pedis infection.
Tinea pedis and tinea unguium arehigh prevalent cutaneous fungal infection in the general population and although these two conditions seem not to be so serious, they are highly infectious, chronic and therapeutically difficult. Perea et al., (2000) evaluated the prevalence together with the risk factors of these two conditions in a study conducted in Madrid Spain. Nail and scales samples were taken from 1,000 subjects of between 20 to 90 years of age presenting signs and symptoms of onchomycosis and/or tinea pedis. Both tinea pedis and tinea unguium prevalence were found to be higher in men than women. Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale are the major etiologic agents followed by yeasts and filamentous fungi such as Scopulariopsis spp. The frequency of these two conditions was found to increase with age with more than half of those with tinea pedis being asymptomatic.
As stated in this paper, treatment of tinea pedis if through the use of antifungals. To assess the effects and costs of oral treatment for fungal infections of the foot (tinea pedis), Haedersdal and Svejgaard (2003) identified randomisd controlled trials from various databases which also included people previously diagnosed with tinea pedis and confirmed by microscopy and dermatophytes growth in cultures. Twelve trials including 700 participants were included in this study with two trials showing a difference of 52% in favour of terbinafine's ability to cure infection when they compared terbinafine and griseofulvin curative ability. Between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole there was no significant difference detected. From all the drugs included in the study, there were adverse effects reported from all of them with gastrointestinal effects being reported mostly. This study concluded that terbinafine is more effective as compared to griseofulvin while treatment with terbinafine plus itraconazole was better as compared to no treatment at all.
A similar study by Korting et al., (2007) to evaluate the efficacy and safety of terbinafine in treatment of tinea pedis they searched 12 electronic data bases and a randomized controlled trials of terbinafine in tinea pedis treatment in comparison with an active placebo as a control. Analysis from this study showed that treatment with terbinafine was superior as compared to the active placebo but no significant difference between the various formulations of terbinafine. Conclusions from this study indicated that terbinafiine is highly effective in treatment of tinea pedis and it’s also well tolerated and therefore terbinafine is better compared to all the other antifungal agents.
Conclusion
Tinea pedis although seems not serious, it can pose serious threats if not taken care of. As seen from my research on this topic, cellulitis is one condition that can get complicated out of neglected tinea pedis. Individuals who are immune-compromised together with diabetic patients are also at a higher risk of complications. Chronic tenia pedis also poses a ond term problem and therefore timely treatment with antifungals especially terbinafine is adviable to individuals presenting the condition.
References
& . (2003). Systematic treatment of tinea pedis--evidence for treatment? A result of a Cochrane review. Pubmed, 165(14), 1436-1438.
Hasan, M., Fitzgerald, S. M., Saoudia, M. & Krishnaswamy, G. (2004). Dermatology for the practicing allergist: Tinea pedis and its complications. Clinical and Molecular Allergy, 2(5)
., , ., . (2007). Comparable efficacy and safety of various topical formulations of terbinafine in tinea pedis irrespective of the treatment regimen: results of a meta-analysis. 8(6), 357-364.
Levitt, J. O., Levitt, B. H., Akhavan, A. & Yanofsky, H. (2010). The Sensitivity and Specificity of Potassium Hydroxide Smear and Fungal Culture Relative to Clinical Assessment in the Evaluation of Tinea Pedis: A Pooled Analysis. Pubmed Central, 1-8
., . & . (2011). Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. Pubmed
Perea, S., Ramos, M. J., Garau, M., Gonzalez, A., Noriega, A. R & Palacio, A. D. (2000). Prevalence and Risk Factors of Tinea Unguium and Tinea Pedis in the General Population in Spain. Journal of Clinical Microbiology, 38(9), 3226--3230
PubMed Health. Athlete's foot. Retrieved on March 17 2012, from
, J. D. & , H. (1996). Association of Athlete's Foot with Cellulitis of the Lower Extremities: Diagnostic Value of Bacterial Cultures of Ipsilateral Interdigital Space Samples. Clinical Infectious Diseases, 23 (5), 1162-1164.