Mixed diagnoses – 10 cases (4 of 11)

Athlete's foot refers to macerated peeling or fissured skin, most often between the fourth and fifth toes. It arises in athletes because of sweating, inadequate drying and exposure to infectious organisms. Athlete's foot is provoked by several factors: dermatophyte fungus, yeast or mould infection; bacterial infection (erythrasma, pseudomonas, staphylococci and streptococci); occlusion and pressure (soft corn); injury e.g. over-vigorous removal of peeling skin; skin conditions such as psoriasis, eczema or keratolysis exfoliativa.

Look for signs of infection, dermatitis or psoriasis elsewhere. In resistant cases, identify specific infection(s) by swabs and careful skin scrapings. Treatment for athlete's foot should begin with general measures. Dry carefully between the toes after bathing; keep toes apart using a cotton or foam wedge. Wear shoes that are loose around the toes or go bare foot; apply a topical antifungal agent such as an imidazole cream or powder. This may also control many of the bacteria responsible for athlete's foot. Whitfield's (benzoic acid compound ointment) is particularly useful as it removes the surface layer of moist peeling skin (i.e. it is keratolytic) and eliminates bacteria and fungi. Make sure that other sites of fungal infection are also treated effectively.