Tinea Pedis

Patients often report prolonged itching and burning sensations, especially between toes, along with peeling, cracking, or maceration (moist, softened areas) in the toe spaces. In chronic cases, they may describe dryness and scaling on the soles or sides of the feet. Some patients also mention intermittent vesicles (blisters) that can erupt, causing significant discomfort. 

Examination reveals three main patterns:

• Intertriginous Type: Maceration, fissuring, and erythema between toes, with silvery scaling.

• Moccasin Type: Widespread dry, scaly patches covering the soles, heels, and sides.

• Vesiculobullous Type: Tense vesicles or bullae on the soles, occasionally progressing to ulcerative, bacterial superinfection if untreated.

For accurate diagnosis, a potassium hydroxide (KOH) preparation can confirm dermatophyte infection.

Effective management combines hygiene practices with topical or systemic antifungal therapy.

Topical Therapy:

• First-line Treatment: Terbinafine 1% (cream/gel) applied twice daily for 1–2 weeks. Other options include clotrimazole, econazole, and ketoconazole, applied once or twice daily for 4 weeks.

• Hyperkeratotic Cases: Adding keratolytics, like salicylic acid, to reduce scaling may improve absorption.

• Hygiene Education: Recommend wearing open footwear in communal areas and using prophylactic tolnaftate powder post-showering.

Systemic Therapy:

When to Consider: For severe, widespread, or unresponsive cases.

Medication Options:

• Terbinafine: 250 mg daily for 2 weeks.

• Itraconazole: 200 mg twice daily for 1 week.

• Fluconazole: 150 mg weekly for 2–6 weeks.

• Griseofulvin: Typically for pediatric patients, dosed by weight, or 1 g daily for 4–8 weeks for adults.

Monitor for Adverse Effects: Common reactions include mild gastrointestinal symptoms, while hepatic monitoring is essential for long-term therapy.