Tinea pedis


  • The most common dermatophyte infection
  • Most commonly in young men
  • Caused by T. rubrum, T. interdigitale, and E. floccosum
  • Spread through direct contact (locker rooms, near swimming pools)
  • Manifests as interdigital, hyperkeratotic, or vesiculobulbous eruption, rarely ulcerative
  • Often accompanied by other forms of tinea

Tinea Types

Clinical Features

Interdigital tinea pedis
Hyperkeratotic tinea pedis
  • Interdigital tinea pedis: pruritic, erythematous erosions between the toes, can be associated with painful fissures (most common type)
  • Hyperkeratotic tinea pedis (mocasin-type): A mocasin distribusion of hyperkeratosis on the soles and side of the feet
  • Vesiculobullous tinea pedis (inflammatory): Pruritic or painful vessicles or bullae with underlying erythema often affecting the medial foot
  • Ulcerative tinea pedis: Interdigital erosions or ulcers (uncommon and usually associated with secondary bacterial infection)

Differential Diagnosis

  • Interdigital tinea pedis
    • Erythrasma
    • Interdigital Candida infection
  • Hyperkeratotic tinea pedis
    • Atopic dermatitis
    • Chronic contact dermatitis
    • Acute palmoplantar eczema
    • Palmoplantar psoriasis
    • Pitted keratolysis
    • Juvenile plantar dermatosis
    • Keratolysis exfoliativa
    • Keratodermas
  • Vesiculobullous tinea pedis
    • Acute palmoplantar eczema
    • Acute contact dermatitis
    • Palmoplantar pustulosis

Foot diagnoses




  • Generally a clinical diagnosis
  • Diagnosis can by confirmed by detecting segmented in hyphae in skin scrapings when put in KOH prep


Coverage for Trichophyton and Epidermophyton and all treatment should be at lease 1 week past resolution of lesions

Topical Therapy

Applies to Tinea corporis, pedis, cruris, and manus

Must use a topical therapy for 7-10days beyond resolution of lesions


  • Griseofulvin 500mg-1000mg PO once daily (20-25mg/kg/d)
    • Usually requires 8wk of treatment
  • Terbinafine for 2-4 weeks is as effective of 6-8 weeks of griseofulvin[1]
    • 62.5mg/day in children <20kg
    • 125mg/day in children 20-40kg
    • 250mg/day in children >40kg[2]
  • Selenium sulfide or ketoconazole shampoos are adjunct treatment
  • Children can return to school during treatment


  • Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks[3]
  • Cephalexin 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
  • Ketoconazole shampoo, isolated towels decrease spread to household members

Tinea corporis

First line should be topical therapy. For refractory cases or severe bullous disease the below anti-fungals are all equivalent options.


  • Outpatient treatment

See Also


  1. Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428
  2. Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.
  3. Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html