Dermatophyte infection of skin of the feet footwear creates the moist warm environment for infection to develop.
Multiple regression analysis has shown that most important risk factor is a family disposition. This was followed by foot deformity, attendance at public swimming baths, male gender, foot trauma, peripheral neuropathy, diabetes and impaired vascular supply .
Acute vesicular pattern:
Usually starts in arch area vesicles and blisters are common may spread to sides of foot. Does not usually affect weightbearing areas. Exacerbated in warmer weather.
Most commonly T.mentagrophytes.
Differential diagnosis – pustular eruptions of the palms and soles (pustulosis palmaris et plantaris); psoriasis
Chronic papulosquamous pattern:
Moccasin type distribution on foot – dry and scaly appearance.
Most commonly T. rubrum.
Scytalidium dimidiatum has been isolated from resistant cases
Chronic interdigital pattern:
Starts in toe web spaces – scaling, maceration, fissuring, erythema and itching.
Most commonly T.mentagrophytes or rubrum.
Inflammatory reactions at sites distant from the dermatophyte infection.
Hand dermatitis common.
Pathogenesis not fully understood, but probably due to a strong immunological reaction to the fungal antigens.
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