Management of Bacterial Overgrowth in Wet Macerated Athlete's Foot

Understanding the Pathophysiology

Macerated ulcers from soaking are particularly associated with Pseudomonas aeruginosa, often in polymicrobial combinations, in patients with wet, macerated athlete's foot 1, 2

The American College of Physicians recommends adding topical terbinafine 1% cream twice daily for 1 week to address the underlying dermatophyte infection in patients with bacterial overgrowth and wet, macerated athlete's foot 3
The Infectious Diseases Society of America suggests considering oral terbinafine 250 mg daily for 1-2 weeks if topical therapy fails in patients with severe or resistant cases of bacterial overgrowth and wet, macerated athlete's foot 3, 4

The American Academy of Dermatology recommends applying foot powder after bathing to reduce recurrence of bacterial overgrowth and wet, macerated athlete's foot from 8.5% to 2.1% 3, 4
The American Podiatric Medical Association suggests treating concomitant onychomycosis, as nail infection serves as a reservoir for reinfection in patients with bacterial overgrowth and wet, macerated athlete's foot 4

The Centers for Disease Control and Prevention advises against overlooking Gram-negative organisms in severe macerated cases, which may require broader antimicrobial coverage in patients with bacterial overgrowth and wet, macerated athlete's foot 1, 2, 5

The American Diabetes Association recommends particular attention to diabetic patients with macerated interdigital spaces, as these fissures serve as portals for streptococcal cellulitis 6
The American Academy of Pediatrics suggests aggressive prevention strategies including daily sock changes and shower sandals for athletes in communal settings to prevent bacterial overgrowth and wet, macerated athlete's foot 7