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CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Thomas (18 years old) is a budding young athlete, who comes to the
pharmacy for advice regarding a rash on his feet. You discover that
Thomas is currently training for several long-distance track events, and
has been spending between four and five hours a day on the track, or at
the gym with his coach.
Over the last few weeks, Thomas has
discovered moist, red and peeling skin
between his toes on both feet. In the last
few days these symptoms have started
to affect Thomas’ training schedule, as his
toes feel irritated and itchy, and he is
experiencing discomfort when wearing
shoes, such as his training runners.
What are the symptoms of tinea
pedis/fungal nail infections?
The feet and toenails are prone
to a variety of infections, as they
are frequently exposed to a moist
environment through the regular use
Two common infections
which affect these areas are tinea pedis
and tinea unguium (onychomycosis).
Tinea pedis (tinea of the feet) is a
common skin condition which typically
affects the interdigital spaces of the foot
and plantar sole.
There are three types
of tinea pedis – interdigital, moccasin
and vesiculobullous, each variety having
a slightly different clinical presentation.
All three forms of tinea pedis generally
cause itch and hyperhidrosis.3
The interdigital type, the most common
form of tinea pedis, typically presents
as scaling and maceration of the
interdigital spaces, starting laterally
(in the third and fourth toe web spaces)
and spreading to the medial toes as the
also experience skin fissures, scaling
and mild erythema.
tinea (appears to cover the foot like a
slipper or moccasin) is often chronic
in nature, with patients experiencing
powdery and scaling plaques
(hyperkeratosis) and mild redness on
the heel, soles and lateral aspects of
1,2,4,5 The vesiculobullous type
of tinea pedis is the least common
form, where symptoms include small
vesicles and blisters on the instep of
the sole (plantar foot surface) which
are extremely itchy and on occasion,
produce purulent exudate.
Onychomycosis is a fungal infection of
the nail that more commonly affects
the toenails and is often associated
with tinea pedis.
It is a common
and chronic condition of the toenail
which causes the nail to become
thick, brittle and flaky.
1,6 The toenail
can often become disfigured and
discoloured (white and yellow lesions)
and the dermis surrounding the nail
often experiences hyperkeratosis.
In addition, the nail plate can begin to
lift off the skin and detach, a process
known as slow onycholysis.
of onychomycosis, distal subungual
onychomycosis (DSO), occurs in the
majority of cases of this infection,
where the distal nail plate and nail
bed are affected.3 In further stages
of this condition, progressive nail
involvement is evident and the patient
can experience total dystrophic
What causes fungal foot
Tinea pedis is a superficial infection
caused predominantly by three major
species of dermatophyte fungus (see
Onychomycosis can also be
caused by dermatophyte fungi, but may
also be attributed to non-dermatophyte
moulds and yeasts, such as the Candida
species.6 Candida onychomycosis is rare
and usually only affects patients who are
Sarah Gray is a Melbourne-based Clinical Education
Pharmacist at the Hydration Pharmaceutical Trust.
After reading this article, pharmacists should be
• Recognise the signs and symptoms of the
different types of fungal foot infections
• Discuss the best treatment options for fungal
• Identify when referral to a doctor is required.
Competency standards (2010) addressed: 3.1, 3.2,
6.1, 6.2 .
Accreditation number: CAP140909A
Fungal foot infections
BY SARAH GRAY MPS
immunocompromised.8 The diagnosis of
tinea often requires the collection of skin
or nail samples, to determine the exact
In cases of suspected
tinea pedis, swabs or skin scrapings
can be taken, and in cases of suspected
onychomycosis nail clippings are
Athletes generally experience
an increased prevalence of tinea pedis
and onychomycosis compared with the
general population due to a number of
athlete-specific risk factors.
factors include exposure of athlete’s feet
to sweating, the use of athletic occlusive
footwear and sharing communal showers
and pools, all of which can predispose
an athlete to developing a fungal skin
or toenail infection.
to sweat can wash away shielding,
antifungal surface lipids on the skin,
leading to softening of the skin and an
increased risk of maceration and trauma.
Additionally, fungal spores can survive in
swimming pools, showers and changing
rooms for months or years, making it
highly likely for an athlete to become
infected with a pathogenic cause of tinea
pedis or onychomycosis.
How can my fungal infection be
treated, and how long do I need to
Tinea pedis is primarily treated with
topical medications which act to
eradicate or inhibit the growth of fungal
Fortunately the majority of
skin infections caused by dermatophytes
respond well to topical therapy in early
stages of the condition and while there
is localised infection.
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