Erosio Interdigitalis Blastomycetica

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Erosio interdigitalis blastomycetica (EIB) comes from the Latin meaning “erosion between the digits caused by a budding fungus”. It is a fungal infection between the toes that causes maceration and is caused by Candida albicans, hence the alternative and probably more appropriate name of ‘interdigital candidiasis’. The name of erosio interdigitalis blastomycetica was first given by Fabry in 1917 before the genus of Candida was described.. The condition mimics other interdigital conditions and the differential diagnosis needs to be carefully considered.

The ICD10CM code is B37.2 (Candidiasis of skin and nail).

Risk factors include hyperhidrosis, too much dampness at places of employment (eg rubber work boots), poor foot hygiene practices (failure to dry between toes), oedema, footwear use preventing evaporation of moisture, diabetes mellitus increases the risk for Candida infections, immunocompromised (especially with the use of corticosteroids).

A series of cases has been reported of erosio interdigitalis blastomycetica as the initial sign of previously undiagnosed diabetes mellitus (link).

EIB can also affect the fingers, especially in those whose hands are frequently in water, such as dishwashers, launderers and bartenders.

Clinical Features of Erosio Interdigitalis Blastomycetica:
The interdigital skin is macerated and there may be a fissure. This macerated skin will eventually peel away and leave a oval shaped denuded, eroded, red ‘raw’ area. There is often itching, some pain and usually a foul odor.

Differential diagnosis: ‘Toe jam‘; Heloma molle (soft corn; painful); interdigital fissure; interdigital erythrasma (coral/pink color under a Woods light), psoriasis alba, tinea pedis (does not have the foul odor of EIB), scabies, interdigital maceration (no itching or foul odor).

Potassium Hydroxide (KOH) mount examination will generally show the pseudohyphae and the budding yeast.
There may be a co-infection with gram-negative bacteria.

Treatment of Erosio Interdigitalis Blastomycetica:
Topical miconazole powder (clotrimzole is effective against Candida) followed by oral fluconazole or itraconazole if the topical is ineffective.
Removal of risk factors with good foot hygiene to dry out between the toes. Advice may need to be given to care givers if self-care is a problem. There are foot care aid products available to help this.
Toe spacers can be used in the short term to help dry out the area.
Castellani paint may be used as well as the astringent and evaporative solutions that are recommended for interdigital maceration could be used, but can be very painful during the initial stages due to the denuded areas of broken skin.

Page last updated: Jun 5, 2022 @ 4:48 am

 
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