Diseases & Conditions
A common fungal condition causing the skin between the toes (usually the fourth and ﬁfth toes) to itch, peel, and crack with diffuse scaling and redness of the soles and sides of the foot. Associated with wearing shoes and sweating, the condition is rare in young children and in places of the world where people do not wear shoes. It is primarily found in adolescent and older men, especially boys who wear sneakers without socks. A person with athlete’s foot is infectious for as long as the lesions exist.
Itchy skin on the foot is probably not athlete’s foot if it occurs on the top of the toes. If the foot is red, swollen, sore, blistered, and oozing, it is more likely some form of contact dermatitis although inflammatory fungal infections can sometimes look like this.
The fungi that are responsible for athlete’s foot are called dermatophytes; they live only on dead body tissue (hair, the outer layer of skin, and nails). The two dermatophytes responsible for athlete’s foot are Trichophyton rubrum and T. mentagrophytes. The condition occurs both by direct and indirect contact; it can be passed in locker rooms, showers, or shared towels or shoes.
Symptoms may include scaling and cracking of the skin between the toes and the sides of the feet; the skin may itch and peel. There may be small water blisters between the toes; it can spread to the instep or the hands. There is usually an odor present.
Scrapings from the affected area will be examined under a microscope for certain fungal characteristics.
The condition may clear up without any attention, but it usually requires treatment. An untreated fungal infection can lead to bacteria-inviting cracks in the skin. The affected area should be kept dry, clad in dry cotton socks or sandals, or kept uncovered. A number of nonprescription fungicide sprays will cure athlete’s foot, including: clotrimazole (Lotrimin), ketoconazole (Nizoral), miconazolenitrate (Monistatderm), sulconazole (Exelderm), or tolnaftate (Tenactin). Before applying, the feet should be bathed well with soap and water, and then well dried (especially between the toes). The sprays should be applied to all sides of the feet twice a day for up to four weeks. After the spray has been applied, the feet should be covered in clean, white cotton socks. For cases that do not respond to the sprays, a physician may prescribe an oral medicine (griseofulvin) or Ketoconazole.
When the acute phase of the infection passes, the dead skin should be removed with a bristle brush in order to destroy the living fungi. All bits of the skin should be washed away.
Good hygiene is the best way to prevent athlete’s foot. Disinfecting the ﬂoors of showers and locker rooms can help control the spread of infection.
Once an infection has cleared up, the patient should continue using antifungal cream now and then—especially during warm weather. Plastic or too-tight shoes and any type of footwear treated to keep out water should be avoided. Natural materials (cotton and leather) and sandals are the best choices, while wool and rubber can make a fungal problem worse by trapping moisture.
Shoes should be aired out regularly in the sun and wiped inside with a disinfectant-treated cloth to remove fungi-carrying dead skin. The insides of shoes should then be dusted with antifungal powder or spray (Desenex). Those individuals who perspire heavily should change socks three or four times daily. Only natural white cotton socks should be worn, and they should be rinsed thoroughly during washing.
Feet should be air dried after bathing and then powdered. It is important to wear sandals or ﬂipﬂops in public bathing areas.