Athlete's foot

　　Athlete's foot is a skin disease of the feet caused by pathogenic fungi and is contagious. Athlete's foot is widely prevalent worldwide, more so in tropical and subtropical regions. In China, the incidence of athlete's foot is also quite high. The soles and interdigital areas of the human feet do not have sebaceous glands, lacking fatty acids to inhibit skin hyphae, resulting in poor physiological defense function. However, these areas have abundant sweat glands, producing more sweat. In addition, poor air circulation, local humidity, and warmth are conducive to the growth of hyphae. Moreover, the skin of the sole has a thick stratum corneum, and the keratin in the stratum corneum is a rich nutrient for fungi, which is conducive to the growth of fungi.

　　During pregnancy, due to changes in endocrine function, women's ability to resist fungal infections of the skin decreases, making them prone to athlete's foot. Obese individuals are prone to tinea pedis due to moist toes and sweat浸渍. Foot injuries can destroy the skin's defense function, which is also one of the factors that trigger athlete's foot. Diabetics, due to insufficient insulin and disordered metabolism, have increased sugar content in the skin, leading to decreased resistance and are prone to athlete's foot. The misuse of antibiotics, long-term use of corticosteroid hormones, and immunosuppressants can also disrupt the normal flora of the skin, increasing the susceptibility to athlete's foot.

　　The occurrence of athlete's foot is also related to lifestyle. Some people do not pay attention to foot hygiene and the condition of their shoes and socks, providing a good breeding ground for fungi.

　　Athlete's foot may also be accompanied by skin fungus infections in other parts of the body. Due to long-term athlete's foot or self-inoculation after scratching with the hands, patients with athlete's foot may also have onychomycosis, tinea manuum, and tinea cruris, among others. When onychomycosis occurs, the nail plate becomes turbid, opaque, showing a cloudy or stained appearance, and the surface loses its luster.

　　Patients with athlete's foot are also prone to bacterial infections. At this time, there is an increase in local secretions, and pale yellow purulent secretions may appear. The infected area is red, swollen, hot, and painful. If timely and appropriate anti-inflammatory treatment is not given, lymphangitis, erysipelas, and cellulitis may occur.

　　(1) Lymphangitis

　　Commonly known as 'red line', in traditional Chinese medicine it is called 'Red Line Rash', which is an acute inflammation caused by pus-forming bacteria entering the lymphatic vessels through broken skin.

　　(2) Erysipelas

　　Erysipelas is a relatively severe acute inflammation. The erysipelas in the lower leg is also known as 'running fire'. It is caused by Streptococcus hemolyticus entering medium or small lymphatic vessels through damaged skin, resulting in acute inflammation of the lymphatic vessels and surrounding soft tissue in the skin and subcutaneous tissue.

　　(3) Cellulitis

　　In traditional Chinese medicine, it is called 'Biandu', usually caused by secondary streptococcal infection. It can also refer to an acute, diffuse, suppurative inflammation of loose connective tissue caused by Staphylococcus aureus, Escherichia coli, and other bacteria. This lesion can occur in the superficial part of the skin, as well as in deeper parts such as beneath the fascia or between muscles.

　　The clinical manifestations of athlete's foot include blisters between the toes, peeling skin, or pale, soft skin, which may also show ulceration or thickening, roughness, and cracking of the skin. It can spread to the plantar surface and edges of the feet, causing severe itching.

　　1. The rash occurs on the sole, edge, arch, and interdigital areas of the feet, as well as the flexor side of the toes.

　　2) It often occurs or worsens in the summer and autumn, and improves in winter.

　　3) The morphology of the rash is divided into three types: vesicular type, ulcerative type, and scale-type. The various types can transform into each other, or they can coexist, but in a certain period, the manifestation of one type is usually dominant.

　　⑴ Vesicular type: Commonly occurs on the arch and sides of the toes. The manifestations are clusters or scattered deep vesicles, like millet in size, with thick vesicle walls. After rupture or absorption, there are a few scales. There is significant itching, often resulting in secondary infection due to scratching or picking vesicles with a needle.

　　⑵ Ulcerative type: Occurs between the toes, especially between the third and fourth toes. The manifestations are local epidermal moisture, whitening due to maceration, and severe itching. It often occurs due to scratching and friction, with the epidermis being peeled off to expose a reddened ulcerous surface, at which time there is itching and burning pain, and the secretion has a special odor. This type is also prone to secondary infection due to scratching.

　　⑶ Scale-type: Occurs on the sole and edge of the foot. The manifestations are hyperkeratosis, dryness, roughness, desquamation, and pale red base. There is slight itching or no itching. In winter, there may be fissures and pain.

　　4) The course of the disease is slow, usually not cured for many years.

　　5) Direct microscopic examination of fungi or fungal culture can be performed to further clarify the diagnosis.

　　1) One of the important measures for preventing beriberi is to strengthen the health supervision and guidance of grain processing, preventing the loss of thiamine during the grinding of grains. In addition, nutrition and health education should be strengthened, especially in rice-producing areas and among those who eat rice as the main food, emphasizing the importance of diversification and balance in dietary instruments.

　　2) The body cannot synthesize thiamine, and its reserve is limited. Although the intestinal bacteria of humans can synthesize thiamine, the amount is very small and mainly in the form of pyrophosphate, which is not easily absorbed by the intestines. Therefore, it is necessary to consume vitamin B1 from food every day. The content of thiamine in natural food is highest in pork at 0.5-1.2mg per 100g (other meats are 0.1-0.2mg), 0.4mg in pork liver, 0.8mg in soybeans, 0.34mg in brown rice, and 0.13mg in polished glutinous rice. The content of thiamine in vegetables, fruits, and eggs is not more than 0.1mg per 100g. Therefore, meats and soy products are good sources of thiamine. It is advisable to increase the intake of such foods for pregnant women, lactating mothers, adolescents, and physically active individuals. In areas where beriberi is prevalent, vitamin B1 prophylactic doses can be distributed for daily use.

　　3) The daily requirement for vitamin B1 is 0.5mg for infants, 1-1.5mg for children, 2-3mg for pregnant women and lactating mothers.

　　4) Adrenal cortical hormones and adrenocorticotropic hormones can counteract the physiological effects of thiamine, blocking the oxidation of pyruvate. Excessive amounts of folic acid or niacin can interfere with the phosphorylation of thiamine in the liver. Diuretics can increase the excretion of thiamine. Attention should be paid to these situations to avoid or exacerbate iatrogenic beriberi.

　　The examination of athlete's foot requires the collection of fresh vesicle walls or deep skin scales for fungal microscopy, which can reveal hyphae and spores. The diagnosis is generally not difficult based on clinical manifestations and mycological examination. Fungal tests can be repeated if necessary. It should be differentiated from tinea pedis, pompholyx, and eczema.

　　Athlete's foot patients should first eat a variety of foods rich in vitamin B1 to supplement a large amount of thiamine. Adults generally need about 1.5 milligrams per day, including various coarse grains, cereals, peanuts, soybeans, brown rice, etc. It is suitable to eat high-protein foods, 1.5 grams per kilogram of body weight per day, and various animal foods can be chosen, such as eggs, milk, fish, and soy products.

　　1, Main food and bean selection: Unrefined wheat flour, soybean powder, millet, corn, rice, etc.

　　2, Meat, egg, and milk selection: Lean pork, pork liver, chicken liver, eggs, etc.

　　3, Vegetable selection: Radishes, eggplants, cabbage, winter melon, etc.

　　4, Fruit selection: Apples, pears, grapes, etc.

　　5, Other: Sunflower seeds, peanuts, cashews, almonds, etc.

　　The general treatment for athlete's foot uses antifungal drugs such as miconazole, itraconazole, terbinafine, etc.; the '1+1' therapy (such as oral and external application of terbinafine for one week) is often adopted during treatment. Local keratolytic agents such as salicylic acid can also be chosen.

　　Athlete's foot should be treated early. Athlete's foot not only affects daily life but also can trigger serious diseases such as erysipelas.

　　Choose the correct medication for athlete's foot. Athlete's foot is caused by fungi, and antifungal drugs should be used. External application of drugs such as Fluocinonide and Derma-Plex cream may have the opposite effect, helping the athlete's foot to spread.

　　Do not stop taking medication on your own. Do not use the alleviation of itching as a standard for cure, but use medication until the fungi are killed.

　　During the treatment period, the socks, underwear, and bedding taken off by the patient should be boiled (above 60℃) to reduce the possibility of transmission.

　　When secondary infection occurs in athlete's foot, local acute inflammation appears. It cannot be treated as general athlete's foot, and secondary infection should be treated first. If there is redness and swelling, external application of boracic acid water or furazolidone solution can be used for cold and warm compress to reduce inflammation and swelling. In necessary cases, systemic administration of antibiotics is also required, and appropriate rest should be taken according to the doctor's instructions.