Dermatology for the practicing allergist: Tinea pedis and its complications

Clinical and Molecular Allergy

Guha Krishnaswamy²  Mahnaz Saoudian¹  S Matthew Fitzgerald¹  Muhannad Al Hasan¹ 

[1] Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA;James H. Quillen V.A. Medical Center Mountain Home, Tennessee, USA

关键词: IgE;    Type 2 T helper cytokines;    Allergy;    Asthma;    Epidermophyton floccosum;    Trichophyton mentagrophytes;    trichophyton rubrum;    antifungal agents;    immunity;    dermatitis;    cellulitis;    Tinea Pedis;   

Others  :  792821
DOI  :  10.1186/1476-7961-2-5

 received in 2003-11-25, accepted in 2004-03-29,  发布年份 2004

【 摘 要 】

Tinea pedis is a chronic fungal infection of the feet, very often observed in patients who are immuno-suppressed or have diabetes mellitus. The practicing allergist may be called upon to treat this disease for various reasons. Sometimes tinea infection may be mistaken for atopic dermatitis or allergic eczema. In other patients, tinea pedis may complicate allergy and asthma and may contribute to refractory atopic disease. Patients with recurrent cellulitis may be referred to the allergist/immunologist for an immune evaluation and discovered to have tinea pedis as a predisposing factor. From a molecular standpoint, superficial fungal infections may induce a type2 T helper cell response (Th2) that can aggravate atopy. Th2 cytokines may induce eosinophil recruitment and immunoglobulin E (IgE) class switching by B cells, thereby leading to exacerbation of atopic conditions. Three groups of fungal pathogens, referred to as dermatophytes, have been shown to cause tinea pedis: Trychophyton sp, Epidermophyton sp, and Microsporum sp. The disease manifests as a pruritic, erythematous, scaly eruption on the foot and depending on its location, three variants have been described: interdigital type, moccasin type, and vesiculobullous type. Tinea pedis may be associated with recurrent cellulitis, as the fungal pathogens provide a portal for bacterial invasion of subcutaneous tissues. In some cases of refractory asthma, treatment of the associated tinea pedis infection may induce remission in airway disease. Very often, protracted topical and/or oral antifungal agents are required to treat this often frustrating and morbid disease. An evaluation for underlying immuno-suppression or diabetes may be indicated in patients with refractory disease.

【 授权许可】

   
2004 Al Hasan et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

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