Athlete's Foot

Itchy, peeling, cracked skin between the toes. A dry scaly sole you have been moisturising for a year with no change. Small itchy blisters along the arch.

All three are tinea pedis, and the reason it gets missed is that only the first looks like what people expect athlete’s foot to look like.

The four patterns

Between the toes is the classic one. White, soggy, peeling skin in the web spaces, usually worst between the fourth and fifth toes, itchy and sometimes smelly. Splits in that skin matter more than they look, because they are an open door for a bacterial infection underneath.

Moccasin pattern covers the sole and the sides of the foot in fine, dry, silvery scale, often with mild thickening. It usually itches very little, which is exactly why it gets treated as dry skin for years. If one foot is scaly and the other is not, that asymmetry is a strong hint it is not simply dryness.

Blistering produces a crop of small fluid-filled blisters, most often on the arch, that can be intensely itchy and come in waves.

Ulcerative is the least common and the most serious: the web space breaks down, often with a secondary bacterial infection on top. This one needs seeing promptly rather than treating at home.

What it gets confused with

This is the practical reason to have it looked at rather than working through the chemist shelf:

• Eczema and contact dermatitis look similar and get worse with an antifungal, because the treatment is not the problem the skin has.
• Psoriasis on the sole produces well-defined scaly plaques that antifungals will not touch.
• Simple dry skin is symmetrical and responds to moisturising. Tinea often is not, and does not.

Where the picture is not clear, your podiatrist can take skin scrapings for laboratory confirmation rather than guessing, which matters most when the first round of treatment has already failed.

How it is treated

Topical antifungal creams or sprays for the great majority of cases, applied to the whole foot rather than the visible patch, and continued for one to two weeks past the point where the skin looks normal. Stopping early is the single most common reason it returns.

Alongside that, the part people skip:

• Dry between the toes properly after showering. Fungus needs moisture.
• Rotate shoes so each pair dries fully for a day between wears.
• Change socks daily, and more often if your feet sweat. Natural fibres or moisture-wicking synthetics over cotton that stays wet.
• Treat the footwear as well as the foot, with an antifungal spray or powder.
• Wear thongs in communal showers while it is active.

⚠ If the toenails are involved, the skin will keep being reinfected. Thickened, discoloured or crumbling nails alongside scaly skin usually mean one infection in two places, and the nails need their own longer course — see fungal nail treatment.

When it is not a minor problem

⚠ If you have diabetes, do not treat this at home. A split between the toes is a break in the skin on a foot with reduced ability to fight infection, and tinea is a well-recognised starting point for cellulitis and for foot ulcers. The same applies if you have poor circulation or a suppressed immune system.

Book a diabetic foot assessment, and in the meantime see a podiatrist promptly for anything that is spreading, weeping, or surrounded by red, hot, tender skin.