Dermatophytosis in Athletes

What is Dermatophytosis?

Dermatophytosis (tinea) is a highly contagious, superficial fungal infection that can affect the hair, nails, and the skin. There are a variety of different kind of species that can cause this fungal infection. The three most common are Epidermophyton, Microsporum and Trichophyton. Clinical classification is according to location.

  • Scalp – tinea capitis
  • Feet – tinea pedis
  • Hands – tinea manuum
  • Face- tinea facialis
  • Head- tinea capitis
  • Nail – tinea unguium (or onychomycosis)
  • Beard area – tinea barbae
  • Groin – tinea cruris
  • Body including trunk, arms, legs and neck – tinea corporis

Tinea pedis and tinea corporis are the two most common fungal infections that are seen in athletes, which are discussed below in more detail.

What are the Signs and Symptoms of Dermatophytosis?

In general it is known that dermatophytosis will present with an erythematous annular patch with distinct borders and a central clearing. The patient will almost always experience itching. Sometimes a fine scale will cover the patch. However depending on the location of the fungal infection, the signs and symptoms may vary.

Tinea Pedis– Also known as athletes foot, has three different clinical types.

  • Interdigital tinea pedis manifests as red erosions or scales between the toes that are pruritic. If left untreated, it may turn into an interdigital fissure and cause pain.
  • Hyperkeratotic tinea pedis is characterized by a diffuse hyperkeratotic eruption that involves the soles and the lateral and medial part of the feet. There may or may not be underlying erythema on the affected areas.
  • Vesiculobullous tinea pedis will present as pruritic and painful vesicular eruption and erythema on the medial aspect of the feet.

Tinea Corporis– Also known as “ringworm”. This will begin as a pruritic circular red patch that spreads outwards. After a day or two, central clearing will occur and a raised border remains.

How do you diagnose Dermatophytosis?

Usually this is a clinical diagnosis. The provider will look at the affected area and inquire about associated symptoms and make the diagnosis. A potassium hydroxide (KOH) preparation will be done to confirm the presence of the fungus if the provider is unsure. Placing a sample of the specimen with a drop of the KOH solution on a slide and observing it under a microscope is how the KOH preparation is completed. This test will reveal segmented hyphae, which is indicative of a fungal infection.

How do you treat Dermatophytosis?

Treatment is recommended to reduce symptoms such as pruritus, to decrease the risk for a secondary bacterial infection, and to assist in limiting the spread of the infection to any other part of the body or other people. Topical antifungal’s are the treatment of choice. There are a wide selection of topical ointments, lotions, creams, sprays and powders. Whichever option the patient decides to choose they must use it two times a day for at least four weeks. Azoles, allylamines, and tolnaftate are effective examples of topical antifungals. However if topical treatment fails, systemic antifungal agents will be used. Examples of these are erbinafine, itraconazole, or fluconazole. According to the National Collegiate Athletic Associations (NCAA) guidelines, the return to play protocol for tinea corporis is that the athlete should be on antifungal therapy for greater than 72 hours and the lesions must be covered. For Tinea pedis there are no current restrictions.

Best way to prevent Dermatophytosis

  1. Always keep your skin clean and dry.
  2. Do not walk barefoot in areas like locker rooms or public showers. Always have a pair of flip flops and wear them on while walking in those areas.
  3. Clip your fingernails and toenails short and keep them clean.
  4. Do not share clothing, towels, sport gear or other personal items with other teammates.
  5. Shower immediately after your practice session or match, and keep all of your sports gear and uniform clean at all times.
  6. Perform daily surveillance and report all abrasions, cuts, and skin lesions to and seek attention from the athletic training staff for proper cleansing, treatment, and wound dressing.

 

By Patricia Zirbo-Cotuna & Mo Mortazavi, MD

 

References:

O’Connell, Claire. 2015. A Comprehensive Review for the Certification and Recertification Examination For Physician Assistants 5th edition.

https://www.uptodate.com/contents/table-of-contents/infectious-diseases/fungal-infections

The Journal of the American Osteopathic Association, June 2011, Vol. 111, 373-379

Dermatophytosis in Athletes

What is Dermatophytosis?

Dermatophytosis (tinea) is a highly contagious, superficial fungal infection that can affect the hair, nails, and the skin. There are a variety of different kind of species that can cause this fungal infection. The three most common are Epidermophyton, Microsporum and Trichophyton. Clinical classification is according to location.

  • Scalp – tinea capitis
  • Feet – tinea pedis
  • Hands – tinea manuum
  • Face- tinea facialis
  • Head- tinea capitis
  • Nail – tinea unguium (or onychomycosis)
  • Beard area – tinea barbae
  • Groin – tinea cruris
  • Body including trunk, arms, legs and neck – tinea corporis

Tinea pedis and tinea corporis are the two most common fungal infections that are seen in athletes, which are discussed below in more detail.

What are the Signs and Symptoms of Dermatophytosis?

In general it is known that dermatophytosis will present with an erythematous annular patch with distinct borders and a central clearing. The patient will almost always experience itching. Sometimes a fine scale will cover the patch. However depending on the location of the fungal infection, the signs and symptoms may vary.

Tinea Pedis– Also known as athletes foot, has three different clinical types.

  • Interdigital tinea pedis manifests as red erosions or scales between the toes that are pruritic. If left untreated, it may turn into an interdigital fissure and cause pain.
  • Hyperkeratotic tinea pedis is characterized by a diffuse hyperkeratotic eruption that involves the soles and the lateral and medial part of the feet. There may or may not be underlying erythema on the affected areas.
  • Vesiculobullous tinea pedis will present as pruritic and painful vesicular eruption and erythema on the medial aspect of the feet.

Tinea Corporis– Also known as “ringworm”. This will begin as a pruritic circular red patch that spreads outwards. After a day or two, central clearing will occur and a raised border remains.

How do you diagnose Dermatophytosis?

Usually this is a clinical diagnosis. The provider will look at the affected area and inquire about associated symptoms and make the diagnosis. A potassium hydroxide (KOH) preparation will be done to confirm the presence of the fungus if the provider is unsure. Placing a sample of the specimen with a drop of the KOH solution on a slide and observing it under a microscope is how the KOH preparation is completed. This test will reveal segmented hyphae, which is indicative of a fungal infection.

How do you treat Dermatophytosis?

Treatment is recommended to reduce symptoms such as pruritus, to decrease the risk for a secondary bacterial infection, and to assist in limiting the spread of the infection to any other part of the body or other people. Topical antifungal’s are the treatment of choice. There are a wide selection of topical ointments, lotions, creams, sprays and powders. Whichever option the patient decides to choose they must use it two times a day for at least four weeks. Azoles, allylamines, and tolnaftate are effective examples of topical antifungals. However if topical treatment fails, systemic antifungal agents will be used. Examples of these are erbinafine, itraconazole, or fluconazole. According to the National Collegiate Athletic Associations (NCAA) guidelines, the return to play protocol for tinea corporis is that the athlete should be on antifungal therapy for greater than 72 hours and the lesions must be covered. For Tinea pedis there are no current restrictions.

Best way to prevent Dermatophytosis

  1. Always keep your skin clean and dry.
  2. Do not walk barefoot in areas like locker rooms or public showers. Always have a pair of flip flops and wear them on while walking in those areas.
  3. Clip your fingernails and toenails short and keep them clean.
  4. Do not share clothing, towels, sport gear or other personal items with other teammates.
  5. Shower immediately after your practice session or match, and keep all of your sports gear and uniform clean at all times.
  6. Perform daily surveillance and report all abrasions, cuts, and skin lesions to and seek attention from the athletic training staff for proper cleansing, treatment, and wound dressing.

 

By Patricia Zirbo-Cotuna & Mo Mortazavi, MD

 

References:

O’Connell, Claire. 2015. A Comprehensive Review for the Certification and Recertification Examination For Physician Assistants 5th edition.

https://www.uptodate.com/contents/table-of-contents/infectious-diseases/fungal-infections

The Journal of the American Osteopathic Association, June 2011, Vol. 111, 373-379

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