In the United States, tinea pedis also known as athlete’s foot, is the most common fungal infection (Dunphy, Winland-Brown, Porter & Thomas, 2015). About 10% of the total population will have tinea pedis (Nigam & Saleh, 2020). It is usually rare in patients before they hit adolescence and has been found to be more common in adult males. Most common ages are between 20-50 years old. In hot humid weather there is increased incidence of tinea pedis and occlusive footwear is a recognized contributing factor (Ferri, 2019). Acute tinea pedis is caused by the fungus Trichophyton mentagrophytes var. interdigitale and chronic tinea pedis is caused by a fungus that is more common, Trichophyton rubrum (Dunphy et al., 2015). Tinea pedis infections are due to maceration, occlusion of toe clefts and wet conditions which all increase the bacterial flora. This leads to skin breakdown from the fungus releasing enzymes called keratinases that invade the keratin layer of the skin. Another component of the infection is the dermatophyte cell walls which contain mannans molecules that suppresses the body’s immune response (Nigam & Saleh, 2020). The physical assessment and examination include a thorough exam of the patient’s feet. Looking for erythematous scaling plaques, blisters and maceration. In between the patient’s toes and soles of the feet should be assessed and typically the infection starts between the third or fourth interdigital web space (Dunphy et al., 2015). During the exam it should be noted if there is a foot odor, if the patient has any pain or pruritus. The patient should be asked if they wear closed toe shoes, if their feet get wet or sweaty and if they wear socks with their footwear. The patient’s evidence-based treatment plan will include prescribing an antifungal. The patient will be prescribed clotrimazole 1% cream and it be applied to the area on the foot twice a day for 4 weeks (Dunphy et al., 2015). Side effects of clotrimazole need to be discussed and these effects can include skin irritation, burning, stinging and itching (Woo & Robinson, 2016). To help keep feet dry, patients can spray an antiperspirant on the soles of their feet where there is normal skin to help prevent overly wet feet. If patients are at risk for recurrence, they will be prescribed miconazole powder to apply to feet twice a day. Patient education needs to include teaching the patient how to keep their feet dry. The patient should be taught to change their socks at least once a day and if their feet get wet in less than 4 hours then socks should be changed twice a day. If socks are worn, they should be cotton or a synthetic wicking blend which has shown to be the best material to keep feet dry (Dunphy et al., 2015). Other ways the patient can help prevent moisture is to wear sandals or open toed shoes during warm weather, and to keep their feet open to air as much as they can. Patients also need to be taught to not scratch their feet during the infection because it can cause it to spread to other areas such as their hands. Feet should also be washed daily and need to be dried completely before putting on socks and footwear. Patients should also be instructed to clean their showers and sheets (if they are white) with bleach. If the patient is using a shower aside from the one in their house, then they should wear shower shoes such as flip flops. The patient should have a follow-up appointment in 2 weeks after starting their medication. At this appointment the tinea pedis will be assessed to see if the antifungal is healing the infection. If the infection is resistant, then a fungal culture will be done at the follow-up. The patient will also be referred to a dermatologist if the infection is resistant to be reevaluated. ReferencesDunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary Care: The Art and Science of Advanced Practice Nursing (4th ed.). Philadelphia, PA: F.A. Davis Company.Ferri, F. F. (2019). Ferri’s Clinical Advisor 2019. Philadelphia, PA: Elsevier.Nigam, P. K., & Saleh D. (2020). Tinea pedis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470421/Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.). Philadelphia, PA: F.A. Davis Company.
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