Saturday, 18 September 2021
AS the Olympics draw near, it seems apt to talk about a condition that many of our athletes may have experienced at one time or another.
No, I’m not talking about a dodgy knee or a keen competitive edge. The clue, as they say, is in the title. Athlete’s foot is a very common condition and, stereotypes aside, something to which all of us are susceptible.
Also known as tinea pedis, athlete’s foot is a form of ringworm and is an infection of the topmost layer of the skin (the dead keratin layer) caused by a fungus.
The technical term for ringworm is dermatophytosis (a dermatophyte is a fungus and not, as the name might suggest, a worm) and it doesn’t just affect the feet.
Ringworm can crop up all over the body; it’s just that the foot of an athlete tends to find itself in the ideal locations and conditions for fungi to latch on to and grow compared with the feet of the general population.
Ringworm thrives in warm, moist environments so a sweaty sock is an ideal place. Add to that the communal elements of locker rooms, perhaps with some towel sharing, and bingo… you have a perfect storm of infectivity. Typically in the feet, one might find scaly, itchy and red patches developing with such an infection.
Between the toes, it can get a bit wet and squidgy but often, the rash associated with tinea pedis can be quite dry. If it is on the soles of the feet, it can cause lots of flaking of the skin but an isolated patch can also take on a circular appearance, most often with a clear ring border that gives ringworm in general its name.
Elsewhere on the body tinea corporis (ringworm on the trunk) has just such a circular appearance. It often develops in small patches, perhaps on the arm or the abdomen, and it may or may not be itchy. Tinea is a word of Latin origin, used to describe the larvae of the clothes moth in the 1600s, hence the probably origin of the term ringworm. It prefixes various other words, each representative of the area of the body affected.
We’ve already had tinea pedis and corporis. It can also affect the nails (unguium), the beard (barbae), the groin (cruris — also known as jock itch) and the scalp (capitis).
Scalp ringworm tends to be more contagious, perhaps because it is more exposed than the rest of the body.
Although not as big a problem nowadays, this was a huge issue in the crowded workhouses of the 1800s. It also significantly affected schools.
Before we knew what caused disease, fungal infections of the skin were lumped in with all sorts of other types of other diseases, including eczema, syphilis and tuberculosis.
It was around 1850 that ringworm was first attributed to a fungus and so, as germ theory was dawning upon people around that time, fungi became contenders to be the culprits for all infectious diseases among some circles.
Treatments around that time were predictably wild. The famous Book of Household Management by Mrs Beeton advised application of sulphur and treacle, creosote and calomel for a bout of ringworm.
Then, when x-rays were discovered at the turn of the 20th century, exposure to these was adopted as a treatment.
For outbreaks in schools, it was even used to treat scalp ringworm en masse and actually become a fairly well recognised therapy.
Of course, there were concerns regarding exposure to radiation and in some cases children suffered burns and ulcers on their skin while others permanently lost their hair.
The process of using x-rays to treat bad ringworm, known as depilation, nevertheless continued for half a century until more long term effects began to emerge. It is thought that around 20 per cent of diagnosed cases of ringworm in the 1930s received x-ray therapy.
Needless to say, these days we steer clear of x-rays for this type of treatment. If you have a bout of ringworm anywhere on the body, your pharmacist is the first port of call. Topical creams such as miconazole and terbinafine are the first line. It is important to use these for the full course, even if you feel the rash has gone, as they can return if you stop too soon. Medicated shampoos are good for the scalp (typically tinea capitis presents with a patch of hair loss with a circular fungal rash in that spot).
For more resistant forms, there are oral medications available from your GP. Those with immune systems a bit below par, for example people on long term steroids or immunosuppressive drugs, are more susceptible and tend to have more severe infections.
It is also always worth checking yourself for signs of diabetes if you are having recurrent and resistant bouts of severe ringworm.
As always, prevention is better than cure. Fungal spores can live on skin scales for up to 12 months so it is worth being cautious to avoid the spread.
Don’t share towels or hairbrushes, try to wear flip flops or sandals in communal changing rooms or showers, change your socks and underwear daily, use talcum powder in your socks to absorb moisture and try to wear loose, breathable footwear and clothing if you can. Try not to scratch affected areas as this can spread the rash.
And finally, if you want to prevent your athlete’s foot developing into jock itch, it’s best to put your socks on before your underwear!
19 July 2021
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