Mixed toe web infection - Skin
The primary event in these infections is damage to the epidermis by dermatophytes. Dermatophytes invade keratinized areas of the body, such as the skin, hair, and nails. The dermatophytes that usually cause only superficial infections of the skin are grouped into three genera: Trichophyton, Microsporum, and Epidermophyton. Damage to the stratum corneum leads to bacterial proliferation and secondary infection. The superinfection is commonly caused by the following organisms, which are present even on normal skin: Staphylococcus aureus, Staphylococcus epidermidis, aerobic diphtheroids, Enterococcus faecalis, Acinetobacter, Klebsiella, Proteus, and Pseudomonas.
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 erosion interdigitalis blastomycetica.
These infections can be disabling, with the threat of sepsis if not adequately treated.
L30.4 – Erythema intertrigo
402933000 – Gram-negative infection of toe web
- Interdigital tinea pedis – This is the underlying factor that causes a mixed toe web infection. There are two types: the interdigital dry type and the interdigital macerated type, which is also called a mixed toe web infection.
- Pitted keratolysis – Shallow, rounded 1-3 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 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.
- Contact dermatitis
- Idiopathic hyperkeratosis
- Dyshidrotic eczema – Presents with pruritus, scale, and deep-seated pinpoint vesicles on the palms, soles, and lateral digits.
- Acrodermatitis continua of Hallopeau (see pustular psoriasis)
- Secondary syphilis – Condyloma lata can be seen between the toes and may be a patient's only manifestation of secondary syphilis.