Monday, January 10, 2011

The most common cause of itching between the toes

“Tinea Pedis” , also called “Athlete’s foot” is the fungal infection of the sole and the web between the toes and also one of the most common causes of itching ( pruritus ) between the toes. In fact the most common place for fungal dermatophyte infection are the feet. Some other fungi result in similar infections. Most of the adult population have experienced this disease during their lives. It can affect most of the age groups from 6 years up but is more prevalent in mature men . It can be seen all over the world. There are two reasons that this disease mainly affects the feet: 1 – The feet are devoid of sebaceous glands . 2 – Plastic shoes provide a closed, warm, and damp area and predispose the environment for fungal growth. This damp environment damages the superficial layers of the skin . In addition bacteria are increased in such an environment.
Many believe that the causative fungi infect the bare feet in the locker rooms or public pools but it hasn’t been determined why at the same conditions , some people are more vulnerable to the disease.
In the following picture you can see a lesion in the space between the fourth and fifth toe of the right foot:

The signs usually include redness, exfoliation, fissuring, and maceration of the toe webs especially between the 2 lateral toes and sometimes the sole of the foot. Itching is one of the common symptoms of the infection which intensifies when the shoes and socks are taken off. Sometimes bacterial infection is superimposed on the fungal infection. If the sole of the foot is infected, the affected area would be pink to red in color and may have mild to moderate scaling. Blistering or ulcerative types of the disease are less common.
The diagnosis is made by the physician after clinical examination . Usually no laboratory test is necessary.
Treatment often consists of local antifungal medications . If there is also a bacterial infection , oral or local antibiotics may be necessary. One of the antifungal creams which can be used is “Clotrimazole”. It should be applied for 2 to 4 weeks to be effective. The patients who reside in the US can use “Lamisil” ( Terbinafine ) cream which is available as an over the counter ( OTC – doesn’t need prescription) drug in chain pharmacies such as “Walgreens” or at department stores. “Lamisil “ is available as 0.42 ounce cream and 1 ounce cream which cost about 10 and 16 US Dollars, respectively. “Lamisil” should be applied 2 times a day for 1-2 weeks. After this period if the disease doesn’t resolve or is associated with ulcers or bulla , you should consult with a physician.
To prevent remissions, you had better use cotton socks and change them once or twice a day! Don’t wear shoes made of synthetic materials and apply absorbent or antifungal powders. Choose wider and roomier shoes specially at the front. Prevent toes attaching together. To achieve this goal you can use “lamb’s wool” strips ( for example “Dr. Scholls lamb’s wool” ). These strips are also useful in preventing corns to recur. Clip your toe nails regularly. Remember that there are a lot of infective microorganisms in old shoes , so get rid of them or reduce their infectivity by applying antifungal and antibiotic powders or sprays. One of these which is available in the US is “Foot Works “ antifungal and deodorant spray which costs about 7 $ . In Iran there are a few similar products including “ Hansaplast “ foot spray from “ Beiersdorf “ (Germany) which is sold at about 4000 to 5000 Tomans each. Tea tree oil is also an antifungal and antimicrobial agent. You can make your own antifungal spray at home by adding 60 drops of the Tea Tree Oil to half a cup of water and ¼ cup of ethanol.