Athlete's foot keeps coming back, can it be cured?

Author: Li Houmin, Chief Physician, Peking University People's Hospital

Reviewer: Yang Rongya, Chief Physician, Seventh Medical Center, PLA General Hospital

Friends who have had athlete's foot know that it is easy to recur, especially in the summer. When the weather gets hot, athlete's foot will recur, making people feel that no matter how they treat it, it cannot be cured.

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Athlete's foot often occurs in humid places, so it is also called Hong Kong's foot; it also has another name, athlete's foot, named after the group of people who are prone to it; in clinical practice, its scientific name should be "tinea pedis".

The onset of tinea pedis is obviously related to the season. Especially in the south, the number of tinea pedis patients increases in summer, because this fungus parasitizes on the surface of the skin, and the warm and humid environment is conducive to its growth.

In the hot summer, the fungus reproduces excessively, and the patient's symptoms will be more obvious. In the fall, when the climate is cool and the fungus reproduces less rapidly, the symptoms will naturally ease. So for some people, the clinical symptoms will ease on their own after a period of time, but in fact the fungus still persists on the skin surface and has not disappeared.

In the northern regions, because the heating is turned on in winter, when it gets very cold, everyone pays attention to keeping warm and wears thick socks and thick shoes, which make the feet not breathable. Therefore, there will be a small peak in the incidence of tinea pedis in the winter in the north.

From the perspective of clinical classification, there are four common types of tinea pedis:

The first type is the blister type, in which small, transparent blisters appear under the skin of the soles of the feet, accompanied by very obvious itching.

The second type is the maceration type. Maceration is a term used in dermatology to describe the morphology of the rash. For tinea pedis, it actually refers to the skin between the toes becoming white, moist, and not itchy, but with a distinct odor, which has a very bad impact on life.

The third type is the papular-squamous type, in which the skin lesions on the soles of the feet are small red bumps, and there are symptoms such as peeling and dandruff, which is called papular-squamous tinea pedis.

If these three types are not treated and continue to develop, they will manifest as keratotic tinea pedis, that is, the skin on the entire sole of the foot becomes thicker and cracks appear on the heels. The subjective symptoms of this type, such as itching, are not particularly obvious. If cracking occurs, the patient will feel pain.

The most common complication of tinea pedis is bacterial infection. For example, in macerated tinea pedis, the stratum corneum between the toes is moist and has small cracks. Since the skin barrier is not particularly complete, bacterial invasion is easier, so the most common complication of tinea pedis should be lower limb erysipelas or bacterial infection of the dorsum of the foot. Bacteria can invade through the cracks in the stratum corneum and spread through the lymphatic vessels. Some people can see a red line on the skin, accompanied by redness and swelling of a large area of ​​skin in the lower limbs, increased skin temperature, swollen inguinal lymph nodes, and some people will have fever symptoms.

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With the change of seasons, some symptoms of tinea pedis can be relieved by themselves, and the symptoms can also improve rapidly after the application of topical antifungal drugs. If the treatment is not thorough, the fungus is not completely eliminated and it is easy to relapse. This requires that in the treatment of tinea pedis, regular and full-course medication should be used. It is generally recommended to use topical and oral medications in combination to better completely eliminate the fungus. If only topical medications are used, for keratotic tinea pedis, in addition to applying antifungal drugs, some keratin peeling agents should also be added.

Of course, even if the fungus is completely eliminated this time, it is still necessary to prevent re-infection, such as keeping the feet dry, so as to completely get rid of the trouble of tinea pedis.