”Foot odor” is a common skin disease, although not a major disease, but the itch is extremely uncomfortable, more annoying is very difficult to cure. “A wildfire can’t burn out, a spring breeze blows again.” It always gets better in the winter and comes back in the spring and summer. What is “tinea pedis”? Tinea pedis is the most common superficial fungal disease that occurs when a specific type of fungus infects the skin of the hands and feet, with tinea pedis being the most common. If there is also trauma to the nails/toenails or if you have diabetes, tinea cruris can spread to the toes/nails and cause onychomycosis. There are many different types of fungi that infect the skin and hair and nails, and ringworm, yeast and mold are the three main types. Dermatophytes are a unique group of fungi that invade only dead skin tissue or its appendages, i.e., cuticles, fingernails/toenails, and hairs. The itching, pain, redness, swelling, or blister formation that occur with the disease are all part of the body’s immune response to the fungus. Tinea pedis and tinea cruris can present clinically as three types and are not identical in appearance. There is the blistering and scaling type, which mainly presents with blisters, itching, and flaking of the skin after the blisters dry up. There is the impregnated vesicular type, which is characterized by impregnated white skin between the toes or fingers, which may have vesicles on the surface and is accompanied by itching. There is the rough and thickened skin on the heel or lower part of the palm of the hand, which tends to crack and bleed, called hyperkeratotic type. [1] Does itchy hands/feet necessarily mean tinea cruris? Do the symptoms mentioned above in the hand and foot area necessarily mean tinea capitis? In reality, there are skin conditions that do behave very similarly to tinea capitis and are even difficult to identify. Therefore, in addition to the typical clinical symptoms, the diagnosis of tinea capitis also requires taking some skin exfoliations and examining them under a microscope. If you see mycelium or spores of a specific shape of a typical pathogenic bacterium, then the diagnosis is basically clear. Some clinical manifestations also help to diagnose tinea capitis. Because it is an infectious disease, ringworm usually has an “inoculation” process, with lesions spreading from one side to the other. Therefore, ringworm tends to start on one side, meaning that you may start with a few small blisters on your left foot and find the same blisters on your right foot after a while. Because the fungus likes humidity, tinea capitis is more common in the summer heat and often starts in the toe or finger crevices and gradually progresses outward. In addition to the three types of manifestations mentioned above, tinea capitis is often accompanied by damage to the nails (onychomycosis). [2] It is important to note that some eczema, psoriasis, and even stage II syphilis can also manifest as some of the symptoms mentioned above, so it is best for non-professionals to go to a regular hospital for these conditions and not to self-diagnose to avoid delaying the condition. Can ringworm be “cured”? Topical antifungal medication is a common treatment for ringworm, but there are some limitations. According to a survey, 82.5% of patients with tinea pedis use topical medications for less than 2 weeks, making it difficult to obtain optimal results [3]. In addition, uneven drug application can easily miss lesions and cause physiological and psychological discomfort to the patient; for scaly keratosis, drug penetration is poor, which has a greater impact on the efficacy. These reasons often lead to poor efficacy and high recurrence rates (50%-80%) with topical treatment alone [3]. Therefore, topical drug therapy alone is only indicated for patients with initial or limited lesions of tinea pedis. Commonly used drugs include azole antifungals such as miconazole, econazole, clotrimazole, ketoconazole, and bifonazole, and other commonly used drugs include terbinafine and ciclopirox. For keratotic skin infections, ringworm of the head, and nail fungus that have extensive lesions or where topical medications are ineffective, it is best to treat with oral medications such as terbinafine (trade name: Lamictal or Tinker), itraconazole (trade name: Spironolactone), etc. Oral medications may also be considered for ringworm with significant inflammation and for the keratotic thickening type of tinea pedis. Studies have shown that the fungal cure rate for tinea pedis treated with oral terbinafine for 1-2 consecutive weeks was 89.3% at 12 weeks, and the annual recurrence rate at 3 years of follow-up was only about 10%; the efficacy and safety of oral terbinafine for 1 week was similar to that of topical clotrimazole cream for 4 weeks. Itraconazole shock treatment for 1 week is also effective, with a mycological efficiency of 56%, but there is a lack of long-term efficacy studies [3]. The disadvantages of oral medications are that they are expensive and a small number of patients can experience drug side effects, but for people with diabetes and immunodeficiency, oral medications are the best choice because of the risk of fungal infection of other organs in the bloodstream. A sufficient course of oral medication combined with topical topical medication can cure tinea capitis. For tinea nail, oral medication combined with a topical topical nail polish-like medication called amorolfine (trade name: Rohypnol) helps to clear the fungus from the local infection. In some cases of ringworm where the skin is cracked and bleeding, ulcers, or secondary bacterial infections such as cellulitis (diffuse purulent inflammation occurring in the subcutaneous tissues) or dermatitis (acute inflammation of the skin and its reticular lymphatic vessels) are emergencies, the principle of treating the symptoms in an emergency and treating the root cause in a slow manner should be followed by treating the more acute cases first and then treating the fungal infection after the bacterial infection is under control. Since fungi have a long growth cycle and fungal spores can survive in human dander for up to 12 months, a full course of medication is essential for the treatment of tinea capitis. Many people give up treatment because they think they cannot be cured, but this is because they do not stick to the medication. Especially in the case of onychomycosis, it is necessary to continue medication until the infection is cleared and the normal toe/nail has grown. Medication for onychomycosis should also be administered under the guidance of a doctor and should last for 6 months for nail and 9-12 months for toenail, with regular follow-up. How can ringworm be prevented? Tinea capitis can be cured, but it can easily recur or be reinfected. Good health habits are essential to prevent tinea capitis, reduce recurrence, and minimize transmission. To prevent tinea capitis, you should pay attention to personal hygiene and avoid sharing slippers, bath tubs, footbaths, towels and other household items. 2. Keep your feet ventilated and dry, and wear breathable shoes and socks. People with sweaty feet can choose socks made of moisture-absorbing and quick-drying fabrics, and avoid wearing shoes with poor ventilation. 3. Actively treat ringworm, and treat ringworm in other parts of the body (especially nail fungus), as well as in family members and pets. Editor’s word: There is also a “foot disease”, which is a systemic disease caused by vitamin B1 (thiamin) deficiency. Don’t get confused!