Clinical Manifestations of Tinea Pedis in Pediatric Patients
Tinea pedis (athlete's foot) in pediatric patients presents as a fine scaly or vesiculopustular eruption that is often itchy, with lesions commonly involving fissures and scaling between the toes, though all areas of the foot may be affected. 1
Primary Clinical Presentations
The clinical manifestations can be categorized into three main forms:
Interdigital Type (Most Common)
- Fine scaling and fissuring between the toes, particularly in the third and fourth web spaces 1
- Maceration of the skin with white, soggy appearance in the toe web spaces 2
- Pruritus (itching) is a prominent feature 1
- May progress from asymptomatic dermatophytosis simplex to symptomatic dermatophytosis complex with secondary bacterial infection 2
- When bacterial superinfection occurs, inflammation, maceration, and odor develop 2
Hyperkeratotic (Moccasin-Type)
- Diffuse scaling and hyperkeratosis involving the plantar surface and sides of the foot 3
- Presents with a "moccasin" distribution pattern 3
- Often less symptomatic than other forms but more chronic 3
Vesiculobullous (Inflammatory Type)
- Vesicles and pustules that may be pruritic 1, 3
- Can involve any area of the foot 1
- Represents an acute inflammatory response to the dermatophyte infection 3
Key Epidemiologic Features in Pediatric Athletes
- Prevalence is significantly higher in adolescent athletes, particularly swimmers and runners, with documented infection rates up to 22% 1
- Male gender predisposes to higher infection rates 1
- Peak incidence occurs between ages 16-45 years, with lower prevalence in younger children 3
- Warm, humid environments (locker rooms, communal showers) facilitate transmission and infection 1
Causative Organisms
- Trichophyton rubrum and Trichophyton mentagrophytes are the predominant causative organisms 1, 3
- T. rubrum accounts for the majority of cases 3
Associated Risk Factors in Pediatric Patients
- Athletic participation, especially swimming and marathon running 1
- Obesity and diabetes are additional risk factors, though less common in pediatric populations 1
- Direct contact transmission from infected family members or contaminated surfaces 3
Important Clinical Pitfall
The accuracy of clinical diagnosis alone is low 3, so while these clinical manifestations are characteristic, confirmation with potassium hydroxide (KOH) examination or fungal culture is recommended before initiating treatment, particularly in cases where the diagnosis is uncertain or treatment has failed 3.