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Athlete’s Foot (Ringworm) in Seniors

Contrary to its common name, athlete’s foot is not only a skin condition that affects the feet of athletes. It is a fungal infection that can affect any person, is more common in certain geographic regions and is likely to afflict the elderly, who have predisposing conditions of the lower leg. Athlete’s foot (tinea pedis or ringworm of the foot) is a fungal infection affecting the skin of the foot typically characterized by scaling, flaking, itching, burning and stinging sensation.

A moist environment is essentially required for transmission and incubation of the causative fungus (Trichophyton). The feet are the most commonly affected body part but can affect other areas of the body, which are usually moist like the groin (jock itch or tinea cruris). Athlete’s foot is a highly contagious disease that spreads through physical contact but easily is treatable with drugs.

Symptoms of Athlete’s Foot

The common symptoms of athlete’s foot are :

  • Scaling, flaking, itching (typically in between the toes).
  • Dryness of skin of the soles or sides of the foot.
  • Blister (with oozing of fluid) and cracked skin may appear.
  • Infection can spread to toenails (onychomycosis) making them discolored, brittle and ragged.

In severe cases there may be dark patches on the skin (hyperpigmentation) even after the infection resolves. The typical ringworm appearance is not always clearly visibly on the feet. This is a red outer ring with the skin at the center being normal. It is a characteristic sign of a dermatophyte infection – a type of fungus that causes fungal skin infections in humans.

Fungal infection makes the person vulnerable to secondary bacterial infection. These bacterial infections can be very severe leading to swelling, pain and pus at the site. Infection with athlete’s foot in some patients induces a particular type of allergic response known as “Id reaction” characterized by appearance of blisters or vesicles (fluid filled lesions) over hand, chest (areas that come in contact with the infected foot).

Causes

Athlete’s foot is caused by group of fungi known as dermatophytes (Trichophyton species). The fungi thrive in moist environment typically in showers, locker rooms and other communal sites. It can also be harbored by pets and be within the soil. The disease is highly contagious, is easily contracted and spreads upon contact with infected person). Sharing of towels and shoes may lead to spread of the infection. For establishment of infection, hot and moist environment is ideal. People who wear shoes (hot and moist environment) without proper drying of foot can suffer from athlete’s foot. Plastic shoes and damp socks particularly favor fungal growth.

Risk factors

  • Men are more vulnerable.
  • Sharing towel, mats, shoes with others.
  • Wearing tight closed (especially plastic) shoes and damp socks.
  • Habit of keeping foot wet for prolonged periods.
  • Heavy sweating.
  • Walking barefoot in communal areas like in showers and locker room

For the elderly, there are additional risk factors. A weakened immune system, and in particular impaired immune defenses in the legs, is seen in conditions such as diabetes mellitus and peripheral artery disease. An injury on the foot and the presence of small cuts or open sores (ulcers) can increase the risk of infection.

Treatment

Some cases of athlete’s foot resolves spontaneously meaning that it goes away on its own without the need for treatment. In case of mild infections, over-the-counter (OTC) applications are sufficient in powder, lotion or ointment forms. In serious cases prescription drugs are required both topically (applied on the skin), or orally (taken internally).

  • Topical includes substances such as clotrimazole, miconazole, nystatin etc. Treatment is to be continued up to 8 weeks after the remission of symptoms.
  • Oral agents includes fluconazole, itraconazole and terbinafine. The drug is taken for 4 to 6 weeks.

Antibacterial creams and antibiotics are not effective for a fungal infection but can be used to treat a secondary bacterial infection at the site.


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