Bacterial intertrigo mimicking interdigital tinea pedis

NewsBot · Mar 12, 2011

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Foot bacterial intertrigo mimicking interdigital tinea pedis.
Lin JY, Shih YL, Ho HC.
Chang Gung Med J. 2011 Jan-Feb;34(1):44-9.

Background: Itchy maceration of the toe webs is common in warm and humid weather. Some cases do not respond to treatment for tinea or eczema.

Methods: Patients with foot intertrigo with a poor response to antifungal or antiinflammatory treatment from 2004 to 2009 were included in this study. Their general characteristics were recorded. Bacterial and fungal cultures as well as potassium hydroxide preparations were performed.

Results: We recorded 32 episodes of foot bacterial intertrigo in 17 patients. The disease was more common in men (82%) and the mean age of the patients was 59 years. The main clinical finding was maceration of the toe webs. The majority of bacterial cultures grew mixed pathogens (93%). Pseudomonas aeruginosa, Enterococcus facealis and Staphylococcus aureus were the most common pathogens. Autoeczematization was present in 50% of the 32 disease episodes.

Conclusion: Foot bacterial intertrigo is not a rare condition and can easily be confused with interdigital tinea or eczematous dermatitis. Proper identification of bacterial organisms is critical for early effective antibiotic therapy. Patients should be instructed about proper foot hygiene, which is important to prevent recurrent infections
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PodGov · Apr 6, 2011

A differential diagnosis of Eythrasma - infecting organism Corynebactrium minitissimum; should always be a differential diagnosis for those cases which do not respond to antifungal management. Woods Lamp is used to diagnose Erythrasma and fluoresces orange-red colour.

Kara47 · Apr 16, 2011

Came across a patient in the last few days with maceration between all toes & blue - green colouring on some. Has been treated with Daktarin for 4 weeks+, so will be referring to GP to swab for Pseudomonas. Has anyone else seen this? Unfortunately didn't have a camera in the clinic:(
Cheers,
Kara

PodGov · Apr 17, 2011

Kara47 said: ↑

Came across a patient in the last few days with maceration between all toes & blue - green colouring on some. Has been treated with Daktarin for 4 weeks+, so will be referring to GP to swab for Pseudomonas. Has anyone else seen this? Unfortunately didn't have a camera in the clinic:(
Cheers,
Kara
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Hi Kara

Did this presentation have a distinct odour? Pseudomomas has an odour that you will not fail to recognise. The patient will need to be on an antibiotic - a topical preparation should suffice - if the infection is not severe. A simple treatment solution is also using acetic acid - simple vinegar.

Cheers

W J Liggins · Apr 17, 2011

Drummond is right. It's always worth using a Woods Lamp to assist in diff diagx.

I note that the abstract of the original paper did not specify whether the population represented in the study had already undergone treatment for tinea. I suspect that bacterial infection secondary to mycosis is more common than generally accepted. Oh well, another piece of research!

Bill Liggins

blinda · Apr 17, 2011

W J Liggins said: ↑

I note that the abstract of the original paper did not specify whether the population represented in the study had already undergone treatment for tinea. I suspect that bacterial infection secondary to mycosis is more common than generally accepted.
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You`re not wrong there, Bill. Risk of secondary infection is one of the main reasons for treating TP;

http://cid.oxfordjournals.org/content/41/10/1416.abstract

http://cid.oxfordjournals.org/content/23/5/1162.short

Cheers,
Bel

NewsBot · Oct 21, 2015

Study of the Etiological Causes of Toe Web Space Lesions in Cairo, Egypt.
Hassab-El-Naby HM et al
Dermatol Res Pract. 2015;2015:701489

Background. The etiology of foot intertrigo is varied. Several pathogens and skin conditions might play a role in toe web space lesions.
Objective. To identify the possible etiological causes of toe web space lesions.
Methods. 100 Egyptian patients were enrolled in this study (72 females and 28 males). Their ages ranged from 18 to 79 years. For every patient, detailed history taking, general and skin examinations, and investigations including Wood's light examination, skin scraping for potassium hydroxide test, skin swabs for bacterial isolation, and skin biopsy all were done.
Results. Among the 100 patients, positive Wood's light fluorescence was observed in 24 and positive bacterial growth was observed in 85. With skin biopsy, 52 patients showed features characteristic for eczema, 25 showed features characteristic for fungus, 19 showed features characteristic for callosity, and 3 showed features characteristic for wart while in only 1 patient the features were characteristic for lichen planus.
Conclusion. Toe web space lesions are caused by different etiological factors. The most common was interdigital eczema (52%) followed by fungal infection (25%). We suggest that patients who do not respond to antifungals should be reexamined for another primary or secondary dermatologic condition that may resemble interdigital fungal infection
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NewsBot · Dec 18, 2015

Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India
A Case-Control Study
Lourduraj John De Britto et al
International Journal of Lower Extremity Wounds December 2015 vol. 14 no. 4 377-383

Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.
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NewsBot · May 21, 2016

Treatment of interdigital foot Erythrasma with ozonated olive oil
Ramirez-Hobak L et al
[URL="http://www.ncbi.nlm.nih.gov/pubmed/27197103?dopt=Abstract"[/URL]

BACKGROUND:
Erythrasma is caused by Corinebacterium minutissimum producing a porphyrin that with Wood's light emits a coral-red fluorescence. It is the most common bacterial infection of the feet. Ozonated olive oil decreases the cytoplasm and damages bacterial proteins and lipids. Treatment is with oral erythromycin and there is no consensus regarding the topical therapy of choice. The aim of this paper is to evaluate the therapeutic efficacy of ozonated olive oil in a pilot trial for Erythrasma.
METHODS:
Experimental, open, observational, descriptive, longitudinal clinical trial at the section of Mycology, of the General Hospital "Dr. Manuel Gea Gonz?lez". Patients: 10 individuals with interdigital feet Erythrasma. Intervention: ozonated olive oil every 12 hours for 10 days was given.
RESULTS:
All patients had disappearance of coral-red fluorescence, erythema, fissures, pruritus, and maceration; two patients persisted with scaling. A cure was obtained in 100 % of patients, similar to oral erythromycin response.
CONCLUSIONS:
Ozonated olive oil is a good topical treatment option for interdigital Erythrasma avoiding oral medications. Larger studies are required.
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zsuzsanna · May 21, 2016

My 15 year old grandson has been suffering with an infection on his foot. It has been suppurating and all dressings soak through in a few hours. He has been to the doctor who prescribed moxacillin and took swabs but the result came back negative. He doubled the dose of antibiotic! I am wondering if it is fungal. He has been referred to a specialist. His big toe is very red and covered with blisters which extend to the interdibital space and the second toe.
I would be grateful for any suggestions. I will try to attach two photos.
The boy lives 200 miles from me so I am not able to examine him myself!

blinda · May 22, 2016

I assume this poor chap is the same one, with similar symptoms, that you posted a few years ago? http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=269253#post269253

In my humble opinion, the comments are still as relevant now as they were then. Let's hope the trigger for what appears to be a contact dermatitis is identified by the specialist.

zsuzsanna · May 22, 2016

Yes! You are quite right it is the same boy two years on! I had forgotten and I believe so did my daughter. But you remembered! Thank you for the link I shall convey the information. I wonder whether the GP had picked up the fact that this has happened before.
Best wishes
Zsuzsanna

blinda · May 22, 2016

zsuzsanna said: ↑

Yes! You are quite right it is the same boy two years on! I had forgotten and I believe so did my daughter. But you remembered! Thank you for the link I shall convey the information. I wonder whether the GP had picked up the fact that this has happened before.
Best wishes
Zsuzsanna
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Memory of an elephant, me. Good pics BTW.

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