TINEA PEDIS: IDENTIFICATION & TREATMENT
It is estimated that fungal infections are the fourth most common problem presenting to Podiatrists, with almost 27 million people affected annually. It is important that physicians and their staff be ready to identify this condition when signs and symptoms show up. The most common causative organisms are dermatophytes and include Tinea Rubrum and Tinea Mentagrophytes. While the definitive diagnosis of tinea pedis is important for a successful outcome, identification of the exact organism is not that crucial. Numerous tests are available to help identify the presence of fungus. Three such tests include:
The KOH technique: Involves skin scrapings treated with potassium hydroxide and examined via a microscope per fungal hyphae. Testing equipment and supplies are cumbersome and test results may be unreliable.
DTM cultures (Dermatophyte Testing Medium): Skin scrapings are placed in a bottle of orange test medium. There will be a red color change along with growth of a colony which is indicative of a positive test. Results may be delayed for up to 2 weeks and may be altered by unwanted contaminates. This method is inexpensive, fairly reliable, and easy to use.
PAS Stain: Preferred method when specific proof is needed for a differential diagnosis. Shave and punch biopsies are easy to perform, provide for rapid results, and are highly reliable.
Treatment of Tinea Pedis must include patient education of the importance of adequate foot hygiene (clean and dry), the use of topical medications (both prescription and OTC) and the occasional use of oral agents.
Topical medications include the four most commonly used preparations - Naftin, Oxistat, Spectazole and Loprox. For the best results and to reduce the chance of reoccurrence, these medications should be used consistently for at least one month. This is due to the time delay of skin turnover and the persistent presence of fungal spores. Thorough patient education, effective identification of causative agents and patience in the treatment regimen will almost always result in good clinical results.
CONDITIONS