Can athlete's foot cause peeling skin on the toes?

Athlete's Foot and Peeling Skin on Toes

Yes, athlete's foot (tinea pedis) commonly causes peeling skin on the toes as one of its primary symptoms. 1 The FDA drug label for terbinafine specifically mentions that athlete's foot presents with symptoms including "itching, burning, cracking and scaling" of the affected skin.

Clinical Presentation of Athlete's Foot

Athlete's foot typically manifests with the following symptoms:

• Peeling, flaking, and scaling skin, particularly between the toes
• Itching and burning sensations
• Cracking of the skin
• Redness and inflammation
• In severe cases, blistering and weeping lesions

Causative Organisms and Risk Factors

Athlete's foot is primarily caused by dermatophyte fungi that break down keratin in the skin. According to the British Association of Dermatologists, the most common causative agents are 2:

• Trichophyton rubrum (most common)
• Trichophyton mentagrophytes

Several risk factors increase susceptibility to athlete's foot:

• Athletic activities (especially runners, swimmers, and team sports participants)
• Communal bathing facilities and locker rooms
• Warm, humid environments
• Occlusive footwear
• Male gender
• Increased age
• Diabetes or immunocompromised states

Research shows that athletes have a significantly higher prevalence of tinea pedis compared to non-athletes. One study found that 69% of professional soccer players had tinea pedis compared to only 20% of male non-athletes and 0% of female non-athletes 3.

Diagnosis and Differential Considerations

It's important to note that not all peeling skin on toes is due to athlete's foot. According to research, only about half of foot lesions in athletes are actually caused by dermatophytes 4. Other conditions that can cause similar symptoms include:

• Bacterial infections
• Contact dermatitis
• Dyshidrotic eczema
• Psoriasis

For accurate diagnosis, a mycological examination (KOH preparation and fungal culture) may be necessary, especially in cases that don't respond to initial treatment.

Treatment Approach

For confirmed athlete's foot causing peeling skin:

1. First-line treatment: Topical terbinafine 1% cream applied twice daily for 1-2 weeks is recommended by the American Academy of Dermatology for its superior efficacy and shorter treatment duration 5.

2. Alternative first-line option: Ciclopirox olamine 0.77% cream/gel applied for 4 weeks is also effective 5.

3. For severe or resistant cases: Oral antifungals may be necessary:

   • Oral terbinafine 250 mg daily
   • Oral itraconazole 100 mg daily for 4 weeks 5

Prevention Strategies

To prevent recurrence of athlete's foot and associated peeling skin:

• Keep feet clean and thoroughly dry, especially between toes
• Change socks daily and use moisture-wicking materials
• Avoid walking barefoot in public areas like locker rooms and pools
• Use antifungal powders in shoes
• Wear well-ventilated footwear
• Avoid sharing footwear or towels

Special Considerations

• Diabetic patients require more aggressive treatment and monitoring due to higher risk of complications 2, 5
• Athletes should take extra preventive measures including regular application of antifungal powders to shoes and feet 5
• Treatment failure may indicate compliance issues, suboptimal absorption, organism insensitivity, or reinfection 5

Common Pitfalls

1. Inadequate treatment duration - Many patients stop treatment once symptoms improve, leading to recurrence
2. Neglecting environmental factors - Not addressing contaminated footwear can lead to reinfection
3. Misdiagnosis - Assuming all peeling skin is fungal without proper diagnosis
4. Overlooking bacterial co-infection - In severe cases, both fungal and bacterial agents may be present 6