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A 38-year-old man presents with an itchy rash on his hands and blisters on his feet for 1 week duration (Figure 140-1). Vesicular tinea pedis with bullae were present. The papules and vesicles between the fingers were typical of an autoeczematization reaction (Id reaction) (Figure 140-2). The patient was treated with an oral antifungal medication and a short burst of oral prednisone for the autosensitization reaction.

Figure 140-1

Vesicular tinea pedis with bullae present. This is an inflammatory reaction to the tinea pedis. (Courtesy of Richard P. Usatine, MD.)

Figure 140-2

The hand shows an autoeczematization reaction to the inflammatory tinea pedis in the previous figure. The vesicles between the fingers are typical of an autoeczematization reaction, also known as an Id reaction. (Courtesy of Richard P. Usatine, MD.)

Tinea pedis is a common cutaneous infection of the feet caused by dermatophyte fungus. The clinical manifestation presents in 1 of 3 major patterns: interdigital, moccasin, and inflammatory. Concurrent fungal infection of the nails (onychomycosis) occurs frequently.

Athlete's foot

  • Tinea pedis is thought to be the world's most common dermatophytosis.1
  • 70% of the population will be infected with tinea pedis at some time.1
  • More commonly affects males than females.1
  • Prevalence increases with age and it is rare before adolescence.1

  • A cutaneous fungal infection most commonly caused by Trichophyton rubrum.1
  • Trichophyton mentagrophytes and Epidermophyton floccosum follow in that order.
  • T. rubrum causes most tinea pedis and onychomycosis.

  • Male gender.
  • Use of public showers, baths or pools.2
  • Household member with tinea pedis infection.2
  • Certain occupations (miners, farmers, soldiers, meat factory workers, marathon runners).2
  • Use of immunosuppressive drugs.

Typical Distribution and Morphology

Three types of tinea pedis

Some authors describe an ulcerative type (Figure 140-6).

Figure 140-3

Tinea pedis seen in the interdigital space between the fourth and fifth digits. This is the most common area to see tinea pedis. (Courtesy of Richard P. Usatine, MD.)

Figure 140-4

Tinea pedis in the moccasin distribution. (Courtesy of Richard P. Usatine, MD.)

Figure 140-5

Tinea pedis in a moccasin distribution that has spread up the leg. (Courtesy of Richard P. Usatine, MD.)

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