Hyperkeratotic Rim of Gram-Negative Toe Web Infections

Gram-negative bacterial toe web infection (GNBTWI) is a frequent therapeutic challenge in clinical practice with high recurrence rates and frequent need of systemic drugs. The aim of this systematic review was to provide an updated overview and evidence-based data on pathogens, risk factors and treatment of GNBTWI along with promoting a consistent international terminology. This systematic review is based on a search in PubMed database for English and German articles published between 1980 and 2016. A total of seven articles were considered appropriate for inclusion in this review regarding to treatment and outcome. Throughout the medical literature, a variety of terms for bacterial toe web infections is used. Only few data on the incidence of GNBTWI were published. GNBTWI has been shown to have a significant male predominance. Pseudomonas aeruginosa is the most commonly identified organism beside a high mixed infection rate. We identified the following predisposing factors: interdigital tinea, occlusion and humidity, history of selfmedication with antifungals, antibiotics and glucocorticosteroids. As for treatment, debridement of macerated skin lesions and the hyperkeratotic rim showed good response in three published cases. Bacteriological workup of swabs including an antibiogram is recommended for identification of the proper topical and systemic therapy. Autosensitization dermatitis and frequent recurrences are common complications of GNBTWI. Despite the fact, that GNBTWI is an accepted disease entity, scarce data on GNBTWI exist in the medical literature. Randomized controlled trials are missing although needed for evidence-based therapy. To facilitate communication and exchange of updates of GNBTWI, we promote the suggested terminology for bacterial toe web diseases.

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“…Debridement of macerated skin lesions and of the hyperkeratotic rim showed a satisfactory response in three published cases …”

Section: Resultsmentioning

confidence: 97%

“…Sometimes local anaesthesia is necessary for debridement. Furthermore, it is postulated that the hyperkeratotic rim, which often surrounds the inflammatory lesion, may inhibit lateral epidermal migration and therefore wound healing …”

Section: Discussionmentioning

confidence: 99%

Gram‐negative bacterial toe web infection – a systematic review

Weidner

Tittelbach

Illing

et al. 2017

Acad Dermatol Venereol

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“…Our case typically demonstrated beefy-red, denuded maceration with a well-demarcated punch-out edge at the interdigital spaces of the feet and metatarsal pads, a finding frequently indicative of GNTWI. Patients with such an uncontrolled or flaring stage tend to develop infectious eczema around primary lesions or antoeczematisation on the trunk and extremities at a long distance (3). GNTWI is liable for one to several episodes, with localised burning, painful or pruritic sensation.…”

Section: Discussionmentioning

confidence: 99%

Toe web malodorous maceration with well‐demarcated punch‐out edge

Tan

Zhang

Zhong-sheng

2014

International Wound Journal

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“…Mechanical debridement of unhealthy tissue might be necessary. 40,41 Negative-pressure wound therapy has been suggested, 30 and cryotherapy for recalcitrant candida has been reported. 42 Proper skin cleansing does not require the removal of all bacteria because resident bacteria are beneficial and rarely pathogenic.…”

Section: Treatmentmentioning

confidence: 99%

“…Additional treatments may include foot soaks in 2% to 5% acetic acid or dilute silver nitrate (0.5%), gentian violet, Whitfield ointment, salicylic acid, zinc oxide, and other barrier creams. Mechanical debridement of unhealthy tissue might be necessary 40,41 . Negative-pressure wound therapy has been suggested, 30 and cryotherapy for recalcitrant candida has been reported 42 …”

Section: Treatmentmentioning

confidence: 99%

Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review

Reynolds

Tusa

Banks

2023

Adv Skin Wound Care

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OBJECTIVE:To present the toe web space as an anatomically, physiologically, and pathologically unique part of the human body; characterize toe web infections and discuss why they occur; and highlight toe web psoriasis as an uncommon condition that providers should consider if toe web intertrigo does not respond to treatment. DATA SOURCE: This review encompassed many years of clinical observation and photographs; medical textbooks; and a literature search of MEDLINE, PubMed, and Google Scholar. STUDY SELECTION: Primary research keywords included intertrigo, toe web intertrigo, toe web infection, tinea pedis, microbiome, skin microbiome, toe web microbiome, ecology, psoriasis, psoriasis microbiome, intertriginous psoriasis, and Wood's lamp. More than 190 journal articles met the search criteria. DATA EXTRACTION: The authors sought data relating to what makes for a healthy toe web space and what makes for disease. They extracted and collated relevant information to compare and contrast among sources. DATA SYNTHESIS: After understanding the normal toe web space and the microorganisms that normally reside there, the authors investigated why infections occur, how they should be treated, what complications may result, and what other diseases occur in the toe web area.CONCLUSIONS: This review of toe web infection illustrates the effect of the microbiome and reports a rare form of psoriasis that is usually misdiagnosed as athlete's foot. The toe web space is a unique part of the human body that can be affected by a variety of both common and unusual conditions.

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Hyperkeratotic Rim of Gram-Negative Toe Web Infections

Cited by 8 publications

References 0 publications

Gram‐negative bacterial toe web infection – a systematic review

Gram‐negative bacterial toe web infection – a systematic review

Toe web malodorous maceration with well‐demarcated punch‐out edge

Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review

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