Tinea manus and tinea pedis are dermatophyte infections that occur on the palms of the hands and plantars and between the fingers (toes), and can also spread to the dorsum of the hands, feet, wrists and ankles. The pathogenic fungus is S. tinea pedis. Epidemiology and susceptibility factors Tinea pedis is the most common superficial fungal disease, with a global average prevalence of about 15%. The causative organisms are mainly Trichophyton rubrum, the most common of which are Trichophyton rubrum and Trichophyton spp. There is some familial susceptibility to tinea pedis, especially the so-called “two-footed, one-handed” type of tinea pedis. Dermatophytes can be transmitted from person to person, animal to person, and contaminant to contaminant. People who share shoes and socks and walk barefoot on public facilities such as public bathrooms, gyms, and swimming pools are susceptible to infection when they are in close contact with the pathogenic bacteria. The prevalence of the disease is higher in people with sweaty hands and feet. Environmental factors also play a role in the onset of the disease, and hot and humid areas and high-temperature seasons are the triggers for a high incidence of ringworm infection. Fourth, clinical manifestations of tinea cruris and tinea pedis can be clinically classified as blister type, interscalene erosion type, and scaly keratosis type. However, several types can exist at the same time in different clinical stages. 1. Blister type The primary damage is mainly small blisters, which are distributed in groups or scattered, with thick walls and clarified contents, which appear to be desquamated after drying and absorption. Often accompanied by pruritus, sometimes itching is severe. 2, interfinger (toe) type 4 to 5 and 3 to 4 fingers (toes) is the most common, mostly seen in the hands and feet sweaty, often immersed in water or long-term wear of rubber shoes, more frequent in summer. The lesions appear as interfinger (toe) erosion, impregnated white, remove the impregnated white epithelium can be seen under the red erosion surface, there may be a little exudate. Patients may feel itchy. Secondary bacterial infection can lead to diseases such as dermatitis or cellulitis. 3.scaly keratosis type The lesions mostly involve the palm and plantar area, showing diffuse skin roughness, thickening, flaking and dryness. It is easy to crack, bleed, and suffer from pain in winter. Tinea cruris has approximately the same clinical appearance as tinea pedis, but the typing is not as obvious as for tinea pedis. The damage often starts with small, scattered blisters, and then often becomes predominantly desquamative, with long-lasting disease presenting as keratinized thickening. The damage is usually limited to one side, often starting at the palm, second, third, or fourth finger, and eventually involving the entire palm. Self-perceived symptoms are not obvious. 5, laboratory tests 1, fungal direct microscopic examination of the damage edge scales or blister wall with 10% potassium hydroxide as a floating solution film, microscopic separation and branching of transparent mycelium or arthrospores that is positive. 2, fungal culture Diagnosis or treatment of difficult cases need to be fungal culture. The positive rate of culture is slightly higher than that of direct microscopic examination, and the clarification of the causative species is beneficial to the selection of drugs and the prevention of relapse. Dermatophyte rapid differentiation medium (DTM) can be used to differentiate dermatophyte infections in a relatively short period of time by changing the color of the medium and is worth promoting. The positive rate of fungal microscopy combined with fungal culture is significantly higher than that of single microscopy or culture. Diagnosis and Differential Diagnosis Based on the clinical features and mycological findings, the diagnosis can be easily confirmed. Tinea capitis should first be differentiated from Candida or non-dermatophyte mycotic infections, because many people who look like tinea capitis and other dermatophyte infections are actually Candida or non-dermatophyte mycotic infections, which are difficult to distinguish by fungal microscopy alone and must be cultured to identify the causative fungus. Studies have shown that about 16% to 49% of fungal infections of the foot are caused by Candida, another 12% are mixed infections, and 1% are caused by non-dermatophyte mycobacteria. Some oral antifungal drugs are not sensitive to Candida or other fungi, so the identification of the species is still important. In addition, it should be distinguished from dermatitis, eczema, sweat pimples, exfoliative keratolytic disease, and palmoplantar pustulosis, which invade the same area. The goal of treatment is to remove pathogenic bacteria, quickly relieve symptoms, and prevent recurrence. Topical drugs, oral drugs, or a combination of both can be used to treat tinea pedis. The severity of tinea pedis, the combination of other diseases and the patient’s compliance should be fully considered when choosing a treatment plan. Topical treatment is based on the type of lesion and the choice of dosage form. For the blister type, a solution should be chosen; for the interphalangeal type, a powder should be used first, followed by a cream; for the scaly keratosis type, a cream or ointment should be chosen. Effective therapeutic drugs include, azoles, acrylamides, morpholinos, pyrrolidones (such as ciclopirox) and thioureas, etc. Some preparations with keratin exfoliation also have certain antifungal effects, such as salicylic acid, etc. Most of the topical medications that have been marketed so far belong to the azole class or the acrylamide class, both of which have significant efficacy against tinea pedis. The representative drugs of the azole class include miconazole, econazole, clotrimazole, ketoconazole and bifenazole, and the course of treatment is usually at least 4 weeks. The arylamides mainly include terbinafine, boutinafine and naftifine, and the course of treatment usually takes 2 weeks. Randomized controlled studies have shown that the efficacy of drugs such as amorolfine, ciclopirox, and lirapamil is similar to the azoles or acrylamides mentioned above. Topical treatment alone is less expensive, has very few systemic side effects, and has a faster onset of action, but has the disadvantages of a longer course, the tendency for the drug to be wiped away by shoes and socks and cause missed lesions, poor patient compliance, and a higher recurrence rate, and is indicated for patients with initial onset, limited lesions, and other conditions of tinea pedis. Systemic treatment The systemic antifungals currently in use are itraconazole and terbinafine. Itraconazole is used at 100 mg/d for 14 d or 100-200 mg/d twice for 7 d. It is most effective at 200 mg/d twice for 7 d for tinea pedis keratosis. The use of terbinafine is 250 mg/d for 7-14 d. Oral fluconazole has also shown good results in the treatment of tinea pedis, but there is relatively little experience with its clinical application in China. a review in the Cochrane database in 2002 suggested that the efficacy of terbinafine was superior to that of ashwagandha, and the difference in efficacy between itraconazole and terbinafine compared was not statistically significant. Oral drug treatment alone has the advantages of shorter duration than topical application, higher compliance, lower recurrence rate, and no missed lesions, but is more costly and relatively slow to take effect than topical drugs. It is suitable for patients with persistent, generalized, poor compliance or ineffective topical treatment, or with lesions that are keratinized and thickened, have a large area of involvement, are macerated and eroded, or have a combination of other systemic disorders (e.g., immune deficiency) that are detrimental to the healing of tinea pedis. A combination of topical and systemic medications is commonly used. This can shorten the course of treatment and improve patient compliance while ensuring efficacy. Supportive treatment ① Wear breathable shoes and keep shoes and socks clean and dry. Shoes can be used with short-wave ultraviolet light and other devices to remove bacteria and pathogenic fungi to reduce recurrence. ②Avoid long-term immersion of the hands and feet in water and other liquids, and use sweat inhibitors such as 6, 25% to 20% aluminum chloride when the palms of the feet sweat a lot. ③Do not share daily life items with others, such as nail clippers, shoes, socks, etc. The results of the study show that short-term oral combined with topical antifungal drugs are as effective as regular courses of oral antifungal drugs for moderate to severe tinea pedis, and better than topical antifungal drugs alone. 2. Tinea capitis The drug selection, treatment principles and treatment of tinea capitis are basically the same as those of tinea pedis. Since a significant proportion of superficial fungal infections of the hands and feet are Candida and non-dermatophyte mycoses and some cases are mixed infections, and the positive rate of mycological examination is relatively low, it is recommended to use broad-spectrum antifungal drugs that are effective against all three types of fungi for the treatment of fungal infections of the hands and feet that are not supported by culture results. Eight, efficacy assessment criteria erythema, papules, scales, blisters, vesicles, impregnation whitening completely disappeared, fungal microscopy and culture are negative.