ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (10)
Mixed toe web infection in Adult
Other Resources UpToDate PubMed

Mixed toe web infection in Adult

Contributors: Rajini Murthy MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

A mixed toe web infection is an infection between the toes that is caused by a primary fungal infection and worsened by secondary bacterial superinfection.

The primary event in these infections is damage to the stratum corneum by dermatophytes. This is superseded by bacterial proliferation and secondary infection. The superinfection is commonly caused by the organisms, which are present even on normal skin, such as Staphylococcus aureus, Staphylococcus epidermidis, aerobic diphtheroids, Enterococcus faecalis, Acinetobacter, Klebsiella, Proteus, and Pseudomonas. Pseudomonas is the most commonly identified organism in gram-negative toe web infection, either alone or within a mixed gram-negative infection.

Bacteria and fungi are more likely to grow in warm, moist environments. Therefore, hot weather, excess sweating, athletic / recreational activities, and closed-toe / tight-fitting shoes can lead to mixed toe web infections, which can appear similar to Candida toe web infections, known as erosio interdigitalis blastomycetica.

Diabetes and smoking are predisposing risk factors for the development of mixed toe web infections.

These infections can be disabling, with the threat of cellulitis or septicemia in immunocompromised individuals, if not adequately treated.

Codes

ICD10CM:
B96.89 – Other specified bacterial agents as the cause of diseases classified elsewhere

SNOMEDCT:
402933000 – Gram-negative infection of toe web

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Interdigital tinea pedis – This is the underlying factor that causes a mixed toe web infection. There are 2 types: the interdigital dry type and the interdigital macerated type, which is also called a mixed toe web infection.
  • Pitted keratolysis – Shallow, rounded, 1- to 3-mm pits present on the pressure-bearing areas of the soles; lesions can coalesce to form furrows, and affected areas may become macerated.
  • Atopic dermatitis – Usually favors the first and second web spaces.
  • Candidiasis – The maceration induced by Candida albicans is less severe than that caused by gram-negative bacteria. Associated with poorly controlled diabetes mellitus. Antifungal therapy alone will result in complete remission. The severe form is known as erosion interdigitalis blastomycetica.
  • Psoriasis – Sometimes psoriasis may be limited to the soles or may present in a palmoplantar distribution.
  • Erythrasma – Brown, minimally scaly plaques with sharp borders. Web space erythrasma is typically hyperkeratotic but can be erosive.
Less common:

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:05/03/2021
Last Updated:06/07/2021
Copyright © 2021 VisualDx®. All rights reserved.
Mixed toe web infection in Adult
Mixed toe web infection : Macerated skin, Web spaces of toes, White scaly plaque, Pruritus
Clinical image of Mixed toe web infection
Macerated scale in the third and fourth webspaces that extends to the base of the fourth toe, with surrounding hyperkeratotic scale.
Copyright © 2021 VisualDx®. All rights reserved.