Tinea Pedis Infection

☐ Adjunctive measures to ensure positive outcomes ☐ Duration of therapy (and to extend 1 week after symptoms resolve unless using terbinafine) ☐ Appropriate application area ☐ If no improvement after 1 week of pharmacologic treatment, or if symptoms worsen, consult primary care provider

Counselling

Directions for application of creams and solutions should include instructions to clean and dry the area and to apply product to visible lesions as well as 2cm to 5cm outside the visible infection. This will help treat fungus which is in the process of spreading. Massage creams into area twice a day for at least 4 weeks. *****************Products should continue to be used for 1 week following resolution to help prevent recurrent infection. ****************** Apply sprays and powders to dry footwear as well as to skin.

Directions for application of creams and solutions

Discuss and recommend appropriate non-pharmacologic measures. Improvement of symptoms such as itching and burning should occur within a few days, and the infection is not contagious after 24 hours of treatment. Although a person should no longer be contagious 24 hours following the initiation of treatment, the patient should be instructed to avoid direct skin contact with others and sharing clothing or personal items, and restrict activities such as wrestling or swimming. Continue treatment for 1 week after symptoms disappear (except with terbinafine). If symptoms worsen, contact pharmacist or patient's primary care provider. Assess Benefit Follow-up in 7 days to assess initial effect. Refer to patient's primary care provider if: Symptoms not improving New lesions or affected area spreading Pain, swelling or more redness as occured Severe sensitivity to medication If symptoms are improving, advise patient to continue treatment and for 1 week after symptoms disappear (except with terbinafine). Assess Adverse Effects Minor redness, itching or stinging does not usually require discontinuation. If symptoms persist or are severe, may indicate contact dermatitis reaction to components of cream. Advise patient to stop therapy and refer to patient's primary care provider.

General Advice / Monitoring

Skin should be kept dry to help stop infection from spreading. Avoid rubbing or scratching lesions. Use a hair dryer on cool setting to dry the affected area. Wear cotton socks. Wear footwear that keeps the feet cool and dry. Avoid going barefoot in public places. Avoid scratching affect skin to prevent spreading. Launder items used by infected person separately and often. Use of non-medicated powders may help absorb moisture. Do not use cornstarch or powders that contain cornstarch as these may provide nourishment for the tinea organisms

Non-pharmacological treatment

Tolnaftate 1% available in solution, gel, powder, cream, spray Clotrimazole 1% available in cream Miconazole 2% available in cream, powder spray

Over-the-counter drug options TC topical - clotrimazole, miconazole, or tolnaftate BID for 4 weeks *****************Products should continue to be used for 1 week following resolution to help prevent recurrent infection. ******************

Athlete's foot occurs most commonly between the toes and may spread to the instep or sole. May be inflamed, blistered and feel itchy, burning or painful.

Signs and Symptoms

Does the patient have risk factors for tinea pedis? ☐ Prone to sweating feet / wears non-breathable socks or footwear ☐ Patient goes barefoot especially in swimming pools or public change rooms ☐ Other family members with current tinea pedis ☐ Yes to any Supports patient's diagnosis

Supports patient's diagnosis

Tinea infections are contagious. Athlete's foot can be spread from person to person through contaminated towels, clothing or surfaces. Tinea dermatophytes proliferate in warm and humid places such as showers, swimming pools and changing rooms.

Tinea Pedis Infection

if the lesions are: Extensive (eg. both top and bottom of feet affected). Severely inflamed Weeping or purulent Painful Disabling NO IMPROVEMENT AFTER 1 WEEK of pharmacologic treatment. Refer for an evaluation. Patient has diabetes or is immunocompromised due to disease or drug treatment. Patient has symptoms of systemic illness (e.g. fever, fatigue, swollen lymph glands). Onychomycosis (fungal nail infection) Onychomycosis does not respond to topical treatment and must be treated with oral agents that can penetrate the infection site. Suspected nail fungal infection should be referred to the patient's primary care provider for oral anti-fungal treatment.

When to Refer