Q. My son is very active. He swims and plays sport. I think he has developed athlete’s foot. What is this and what can I do?
A. Athlete’s foot is a fungal infection of the feet. It may occur more commonly in people who are prone to sweaty feet.
It presents as itchy, scaly white or red patches between the toes and on the soles of the feet.
Treatment is with antifungal creams or powders and is generally needed for a period of two to six weeks depending on the severity and response to treatment.
Sometimes the fungal infection may spread to the nails. If this happens you may notice yellow discolouration and distortion of the nails.
This may respond to the application of special antifungal paints which will generally be tried first line as treatment. It may take several months for a fungal nail infection to heal and persistence will be necessary to ensure it is fully treated.
If there is a very poor response to this nail paint, or there is extensive involvement of many nails, your GP may prescribe antifungal tablets.
Many children and adults who swim are prone to the development of plantar warts or verrucas. They are caused by the wart virus and may be transmitted by direct skin contact.
Risk of passing the virus on to another person is low. However, in wet skin or skin which is broken, the risk of transmission is increased.
Treatment with over-the- counter creams such as salicylic acid can be very successful — again persistence is necessary as the verruca may be slow to respond.
Cryotherapy (or freezing) is another option which is carried out by many GPs. The wart will be frozen with liquid nitrogen, and a course of a few weeks may be necessary before the verruca is fully treated.
Ensure your child dries his feet well after sport or after the swimming pool. Wearing flip flops in the shower/ changing room can also help reduce the transmission of infections.
Q. My mother is 84 and has recently been diagnosed with cellulitis of the foot by the out-of-hours GP service. How did she get this?
A. Cellulitis is a skin infection, it can be caused by a variety of bacteria that often colonise the skin of healthy individuals. This bacteria is mainly from the Streptococcal group, Staphylococcal infection may also be responsible including colonisation with MRSA which is more difficult to eradicate.
Certain risk factors will increase a person’s risk of being susceptible to skin infection; these include immunosuppression, older age, diabetes, and broken skin from trauma or conditions such as fungal skin infection or untreated eczema. Cellulitis may affect people of all ages and is equally as likely to develop in men and women.
In cellulitis, the affected skin will become red, swollen, hot and tender and if left untreated, infection may spread upwards to involve a large amount of skin.
It is most common for cellulitis to develop on the legs and lower limbs, however, it can occur anywhere. Treatment is most usually with a one to two-week long course of antibiotic and your GP may need to review you after this period to make sure the infection is fully cleared.
If redness is worsening or spreading up the leg it may be necessary to increase the dose or method of administration of antibiotics. For cellulitis that will not clear with tablets, a course of IV antibiotics may be necessary.
Once the cellulitis has cleared there are a number of things which can reduce the likelihood of recurrence.
It is important to keep the legs moisturised to avoid cracks caused by dry skin which may let in infection. Treatment of any co-existing fungal nail or skin infection such as athlete’s foot is also important.
Keep the legs elevated at rest as well as the use of compression stockings to reduce leg swelling, which may increase the risk of cellulitis developing. A past history of cellulitis may increase the likelihood of having a further episode.
Patients with diabetes should be particularly careful about monitoring for signs of infection as it may be severe in patients with this condition.
Good foot care at home, wearing appropriate foot wear, as well as regularly attending chiropody appointments may also help prevent recurrence.
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