Tinea Pedis

  • Etiologia
    • T. rubrum causes most infections
    • There may be an autosomal dominant predisposition
    • Non-dermatophyte pathogens that produce clinical findings identical to tinea pedis
      • S. dimidiatum
      • S. hyalinum
    • Most common form of skin fungal infection
  • Apresentação clínica
    • NO SEBUM
    • Can become secondarily infected
    • Hiperqueratósica (em Mocassin)
      • Chronic/resistant
      • Fine, silvery scale with pink tender/itchy skin
      • 2 hand, 1 foot or vice-versa
      • T. rubrum most common
      • Kodachrome on boards
    • Interdigital
    • Bullous - associated with T. mentagrophytes
    • Ulcerada (imunocomprometidos e diabéticos)
      • Tratamento: Antifúngico oral
    • Vesicular ou inflamatória
      • Inflammatory fungal infection
      • Chronic infection with occlusive footwear
      • Vesicles and bullae on sole
      • KOH from roof of blister skin
      • T. mentagrophytes most common
      • Dermatophytid reaction
        • Itchy sterile vesicles - allergic response on fingers, chest and arms
    • May have “id” reaction in the hands
  • Tratamento
    • Topical - appropriate for tow webs
      • Azoles - bacteriostatic - block ergosterol synthesis
        • Mecanismo: Lanosterol 14 alfa demethylase - CYP450 dependent
        • Econazole and other azoles
        • Luliconazole 1% cream - once daily for 2 weeks
      • Allylamines - bacteriostatic/bactericidal - inhibit squalene epoxidase
        • Block ergosterol synthesis - CYP 450 independent
        • Terbinafine
        • Naftifine 2% gel and cream - once daily for 2 weeks
          • Anti-dermatophyte - less activity against yeast
          • Potent fungicidal activity
          • Dry, scaling plaques
      • Mycoster ciclopirox tem solução cutânea (spray) ou creme
        • Use for 2-4 weeks until 1 week s/p scale gone
      • Nystatin
      • Antifungal powder/sprays to shoes every week
      • Combine 40% Urea
    • Orais
      • Indicações para tratamento oral:
        • Extensive chronic hyperkeratotic tinea pedis or inflammatory/vesicular tinea pedis
        • Concomitant onychomycosis, diabetes, peripheral vascular disease, or immunocompromising conditions.
      • Terbinafine 250mg/dia durante 2 semanas
        • EADV Copenhaga: mais eficaz de itraconazol
      • Itraconazol
        • Curso EUA: 200mg BID durante 1 semana
        • No serviço: 200mg id 1 semana ou 100mg 2 semanas na tinea pedis
      • Fluconazole 150mg once weekly for 4 weeks
      • Griseofulvin
    • Casos particulares
      • Moccasin type
        • Oral terbinafine 250mg bid x 2-6 weeks +/- topicals
      • Vesicular type
        • Oral terbinafine 250mg bid x 2 weeks
        • Potassium permanganate
        • Burow’s solution
      • Se sobreinfecção: ciprofloxacina 500 12/12 para cobrir germens como corinebacterium minutocimo (da queratolise punctata) e pseudomonas