How common is tinea pedis in children?

Fungal infection is a topic that I have covered extensively on my blog but considering how common it is, it is perhaps deserving of that attention particularly as the most common foot infection we come across in the podiatry clinic. In a previous blog I asked “How common is onychomycosis in children” – as a co-exiting condition, I'm asking the question, "How common is tinea pedis in children?"

How common is tinea pedis in children?

Tinea pedis in children

In the earlier article on childhood onychomycosis (Click Here) studies suggested a rate of between 0.6-2.6% have nail infection [1] . Looking at the literature, there are many studies looking at nail infection but tinea pedis in children fails to get so much attention, possibly as treatment is not so challenging as it is for fungal nail infection. However, if one is looking to prevention of fungal nail infection, tinea pedis is critical as skin infection frequently leads to nail infection [2, 3].

A recent paper published in Pediatric Dermatology has been investigating the prevalence of the condition in this age group [4]. The systematic review trawled the published literature up to late 2024 looking for any paper which had a sample size of 100 children or more (aged 0-19). Of course, there are many ways in which it can be diagnosed, and the researchers analysed this aspect into sub-groups to look for any trends or patterns.

The results showed that prevalence rates were generally much lower than in adults which was to be expected, across various countries reporting the prevalence ranged from 0.1% - 15.65% (one study in Turkey). The research was not able to show that prevalence increased with age in the collated studies.

How common is tinea pedis in children across the world?

The included published studies were conducted between 1959  to 2020, a span of 61 years. Collating the data by continent :

Europe 3.32%

Asia 4.11%

Middle East 1.0%

Africa 2.79%

South America 6.35%

Australia 5.20%.

 

What are the common fungi that cause tinea pedis in children?

As with adult populations, the predominant species were dermatophytes making up 96% of isolates (T. rubrum accounting for half of this group, 42% T. mentagrophytes and E. floccosum some way behind at just 5%). Yeasts accounted for just 4% percent.

Why is tinea pedis less common in children?

Previous work has looked at how the microbiome on the skin changes through childhood and puberty. One study saw a distinct change at puberty to more an adult profile of common skin inhabitants [5]. Potentially, puberty which leads to increase sebaceous activity, may favour more lipophilic organisms we see in adults, although its relevance to the foot is questionable as there are few functioning sebaceous glands in this area of the body.

Changes in the fungal microbiome have been studied in children and young adults compared to adults [6]. Although feet were not specifically studied, the authors concluded that fungal microbiome in children was far more diverse until puberty. Differences in the fungal microbiome were also found between females and males before puberty, when in adults it was not so gender specific. Higher rates of dermatophyte skin infection have also been reported in children with Down syndrome [7-9].

 

Treatment of tinea pedis

In the United Kingdom, treatment for tinea pedis is generally straightforward. Over the counter medicines such as clotrimazole (available as a generic cream and as Canesten®), miconazole (Daktarin®) and econazole (Pevaryl®) are all indicated for use in athletes’ foot for children of any age. Although effective, terbinafine cream is only licenced for use in children over the age of 12. However, off licence use of terbinafine cream has been found to be effective and safe in children and is listed in the children’s BNF (as an unlicensed product).

 

Summary

Although tinea pedis is considered rare in children, it still occurs, much like onychomycosis. In Europe this is estimated to be around 3.3% based on limited literature from a few countries over a  considerable time span so may not truly reflect the true prevalence rate. However, when it does arise, topical azoles are the drugs of choice in younger children which should be effective as the overwhelming fungi involved are dermatophytes.

 

References

1.            Solís-Arias, M.P. and M.T. García-Romero, Onychomycosis in children. A review. International Journal of Dermatology, 2017. 56(2): p. 123-130.

2.            Elewski, B.E. and A. Tosti, Risk Factors and Comorbidities for Onychomycosis: Implications for Treatment with Topical Therapy. The Journal of clinical and aesthetic dermatology, 2015. 8(11): p. 38-42.

3.            Bristow, I. and Y. Mak, Fungal foot infection - the hidden enemy. Wounds UK Journal, 2009. 5(4): p. 72-78.

4.            Stenderup, J.E.B., N.F. Goandal, and D.M.L. Saunte, Systematic Review of the Prevalence of Tinea Pedis in Children. Pediatr Dermatol, 2025.

5.            Park, J., et al., Shifts in the skin bacterial and fungal communities of healthy children transitioning through puberty. Journal of Investigative Dermatology, 2021.

6.            Jo, J.-H., et al., Diverse Human Skin Fungal Communities in Children Converge in Adulthood. Journal of Investigative Dermatology, 2016. 136(12): p. 2356-2363.

7.            Ryan, C., et al., Dermatologic conditions in Down syndrome. Pediatric Dermatology, 2021. 38(S2): p. 49-57.

8.            Castellanos, J., et al., Onychomycosis in Children with Down Syndrome. Current Fungal Infection Reports, 2018. 12(4): p. 207-212.

9.            Madan, V., J. Williams, and J.T. Lear, Dermatological manifestations of Down's syndrome. Clinical and Experimental Dermatology, 2006. 31(5): p. 623-629.