Q: I'm a 20-year-old college student who tries to swim at least twice a week. Recently I noticed scaling and itching on the soles of my feet and between my toes. What could it be, and what can I do about it?

A: Don't be fooled by the name: Athlete's foot doesn't affect only people who swim or run or toss around a football. It's a common fungal infection of the skin that can develop in anyone putting on tight, unventilated shoes, walking barefoot across a locker room or stepping into a shower or other warm, moist place where fungus grows. Men are more susceptible than women, while adults and older teens are more prone to the problem than children under 12.

"One of the things about athlete's foot is it can be prevented and it can be managed . . . very successfully when it's done quickly," says Jon Almquist, who oversees the athletic training program for Fairfax County's high schools. "You know what works best? When one kid gets it and complains to other kids and puts them on their guard."

Symptoms of athlete's foot include cracked, peeling areas between the toes. In addition, there may be scaling on the soles and sides of the feet or the back of the heel, redness and itching. While athlete's foot is more common in a dry, scaly form, it can manifest itself with blisters and weeping, oozing lesions on the skin.

People may not notice athlete's foot for months or even years, and mild cases may flare up periodically. But if left to worsen, the fungal infection can spread to toenails, causing discoloration, crumbling and thickening nails and creating a problem that's difficult to treat. Or the fungus may penetrate deeper into dry, cracked skin and cause a secondary bacterial infection, characterized by swelling and pus.

Standard Treatments

"A shoe is fungus heaven," says Stephen Pribut, a podiatrist who has been in private practice in the District for 19 years. Pribut daily sees patients with athlete's foot, in many cases when they are seeking treatment for broken bones, sprained ankles or other ailments and don't even realize the fungus is there.

An increasing number of anti-fungal products is available over-the-counter as creams, powders or sprays. They range from Lotrimin and Micatin, so-called "azole compounds," which usually take care of fungus and yeast infections by killing the organisms, to Zeasorb, which works as a drying agent. Pribut says if one of his patients is troubled by the problem, he tries a prescription medicine that he thinks will work the first time. He and others stress that it's important to take all medication, even if skin looks better, and taper off to prevent sudden flare-ups.

To handle a serious condition, there are prescription oral medicines, such as Nizoral (ketoconazole), which must be used carefully to avoid liver damage over the long term. Physicians may also prescribe topical medicines, including Mentax (butenafine), usually applied to the infected area once a day for about a week.

Pribut, who is also a clinical assistant professor of surgery at George Washington University Medical Center, says the most important step "is moisture control. Dry your feet thoroughly and dry between the toes. If you're prone to fungus, find alternatives to nylon stockings, or change socks at midday if you're having a flare-up. For long-distance runners and people prone to infection, non-cotton socks are better."

Pribut warns not to take drastic measures that could harm the skin: "I've heard of people being told to put their feet in bleach, and I think that's a terrible idea."

When a patient is prone to a recurrence of athlete's foot, says Mervyn Elgart, clinical professor of dermatology, medicine and pediatrics at George Washington University Medical Center, he puts him on a prescription medication that is applied weekly as a preventive measure. People with poor circulation, including those with diabetes, may encounter more persistent cases of athlete's foot. "It's potentially more serious then, and should be treated aggressively enough to take care of it," he says.

"The idea is to keep the foot as dry as possible," says Paul Honig, a dermatologist at Children's Hospital of Philadelphia. He suggests applying cornstarch, rotating shoes so they dry out well and eliminating caffeine from one's diet "because it makes you sweat." He cites "a high incidence of recurrence [of athlete's foot] even with the new medication."

Alternative Measures

Kevin Conroy, a naturopathic doctor at Bastyr University Natural Health Clinic in Seattle, agrees that the best approach involves proper foot hygiene. But he also would use tea tree oil and/or oregano oil; these oils, he says, usually clear up athlete's foot. Many herbs have anti-fungal properties, he says, but by keeping the feet dry and clean, you can eliminate a lot of fungi.

Jill Stansbury, who is chairman of the botanical medicine department at the National College of Naturopathic Medicine in Portland, Ore., recommends daily foot soaks of one part vinegar to three or four parts water, followed by thorough drying. Then she'd apply tea tree oil, either by rubbing salves onto the foot or by wiping out shoes with a couple drops of the oil on a cotton ball. If she finds evidence of a more systemic fungal infection in the body, she'd combine grapefruit-seed extract with oregano oil and caprylic acid.

Family physician Fred Mansubi, in practice 30 years in San Jose, Calif., calls himself a holistic physician. But he says athlete's foot "is one condition that's more easily treated and costs less using conventional treatments rather than alternatives." He says tea tree oil and garlic have antiseptic properties that could be helpful in treating the condition, and he wouldn't object to the use of calendula ointment. But, he adds, "it's not really that difficult to treat, and we have safe and effective and cheap medications. . . . What I would tell the patient is [the] things to do to prevent" athlete's foot--keeping the foot as cool and dry as possible. "It's one condition that's more easily prevented than treated."


* American Podiatric Medical Association:

www.apma.org or 800-366-822.

For a free brochure, write to APMA, 9312 Old Georgetown Rd., Bethesda, MD 20814

* American Academy of Dermatology:

www.aad.org/pamphlets/AthletFoot.html or 888-462-3376.

Treatment of Choice is an educational column and is not a substitute for medical advice from your physician. To ask questions or suggest topics for coverage, send e-mail to health@washpost.com or faxes to 202-334-6471. You may also reach us by U.S. mail at Treatment of Choice, Health Section, The Washington Post, 1150 15th Street NW, Washington, DC 20071.