Is tinea pedis underdiagnosed in children? Study in Barcelona school children

Tinea pedis is less common in children than in adults and rarely appears before the age of four years. A cross-sectional study was performed to determine the prevalence of this type of tinea in school children in Barcelona, Spain. A total of 2,613 school children with the ages from 3 to 15, from 39 schools located in the municipal district in the vicinity of the hospital, were examined to identify the presence of dermatophytosis of the feet. Seventy-two had positive cultures for tinea pedis and dermatophytes, while in three, the nail was involved as well. The overall prevalence was 2.75%, and increased with age, being 0.86% in 3 to 5-year-olds, 2.08% in 10 to 12-year-olds and 7.04% in 13 to 15-year-olds. The fungi found were Trichophyton mentagrophytes (48.6%), T. rubrum (40.27%), Epidermophyton floccosum (6.94%) and T. tonsurans (4.16%). Of these 72 children, 49 had interdigital lesions, only 19 of them were aware of their presence and 8 had received antifungal therapy previously, although not consistently. Although the incidence of tinea pedis is low in children, we think that it is underdiagnosed. Possible reasons for this could be the limited interest in the lesions on the part of parents, who consider them trivial and do not mention them during physical examinations; the consideration that the condition is characteristic of the age group and is associated with sports and the generalized use of athletic footwear; the lack of proper foot hygiene after doing sports; the fact that there are few subjective symptoms; the failure on the part of the pediatrician to systematically and carefully examine the interdigital skin of the feet of healthy children; the lack of an accurate differential diagnosis; the reluctance of adolescents to visit the pediatrician; self-diagnosis and self-medication.