Erosio Interdigitalis Blastomycetica is a specific form of candidiasis in the web spaces between the fingers and toes. It classically presents as central erythematous macerated lesions with peripheral scaling involving at least one finger or toe web space. It often occurs in people who frequently immerse their hands in water, such as dishwashers and launderers.
Causes
The condition is a special form of candidiasis that mainly affects the third web space between the fingers and toes, though it can spread to other web spaces. It classically presents as erythematous macerated ulcers with surrounding superficial satellite papules and pustules on the web spaces of the fingers or toes. It is often associated with pain. Predisposing factors include hyperhidrosis, poor foot hygiene (especially in those whose work involves frequent hand washing), footwear preventing the evaporation of moisture, diabetes mellitus which increases risk for Candida infection, and immunocompromised patients including those taking corticosteroids.
Candida is a unicellular fungus that reproduces by budding, which entails the progeny pinching off of the mother cell. The condition most often occurs in those whose hands are frequently exposed to water such as dishwashers, launderers, and bartenders.
Symptoms
Erosio interdigitalis blastomycetica is a condition in which the yeast Candida albicans causes a painful and itchy infection between the toes. Typically, it appears as an oval-shaped area of red and macerated skin in the web spaces between the toes. It may also appear as painful fissures or erosions.
The fungus thrives in warm and moist environments, which are ideal conditions for infection. Risk factors include excessive sweating, poor hygiene practices (failure to dry the skin between the toes), wearing non-breathable footwear, diabetes mellitus (which increases susceptibility to fungal infections), and compromised immune systems.
Diagnosis includes recognition of consistent clinical features and a careful history to identify predisposing factors. Laboratory tests such as a potassium hydroxide mount for candida and fungal cultures of skin scrapings are performed to confirm the diagnosis. Topical antifungal creams or ointments and oral medications are commonly prescribed to treat the condition. Proper hygiene, keeping the affected area clean and dry, and wearing breathable footwear can prevent the recurrence of this uncomfortable and embarrassing condition.
Diagnosis
It is usually recognized by the presence of a central erythematous erosion surrounded by a rim of macerated skin involving the interdigital web spaces. The resulting ulcers are often painful, itchy and may have a foul odor. The diagnosis is made by recognition of consistent clinical features in addition to fungal microscopy and culture of skin swabs or scrapings. Skin biopsy is rarely performed. The differential diagnosis includes heloma molle, dermatitis herpetiformis, tinea pedis and irritant contact dermatitis. A KOH mount of the lesion confirms the diagnosis by demonstrating septa-free hyphae and budding yeast forms.
This condition is more commonly found in people who frequently immerse their hands in water, such as dishwashers, launderers, and bartenders, although it can affect anyone. It is especially common in diabetic patients whose blood sugar levels are not controlled adequately and may lead to increased susceptibility to Candida infections. It is important to screen for diabetes in patients with this problem.
Treatment
Erosio Interdigitalis Blastomycetica is a fungal infection of the web spaces between the toes or fingers that can cause red, itchy, and painful erosions. The condition is characterized by a balance disruption between the normal flora and yeast, or Candida, which overgrows in warm and moist environments. The condition can be easily treated with topical antifungal creams or ointments. Practicing good foot hygiene, wearing breathable footwear, and avoiding excessive moisture can prevent the condition from reoccurring.
Diagnosis of the condition typically involves recognition of consistent clinical features, and microscopic examination of skin swabs or scrapings with potassium hydroxide (KOH) mount examination to visualize the yeast cells. Culture of the sample can identify the specific yeast that is causing the infection.
Risk factors include poor hygiene practices, sweaty feet and hands, diabetes, obesity, and tight-fitting shoes. Individuals with these factors are more likely to develop the condition than those without them. Infections may also be exacerbated by other conditions, such as psoriasis and tinea pedis.