An atypical presentation of Tinea pedis as anhydrotic fissured heels in a middle-aged woman: A case report

Tinea pedis is the most common cutaneous dermatophytosis, presenting as peripheral fissuring and burning sensation associated with pruritus. Clinical presentations of Tinea pedis are interdigital, hyperkeratotic (moccasin-type), and vesiculobullous (inflammatory) forms. Topical antifungal therapy and good personal hygiene are the mainstay of treatment in Tinea pedis. In Ayurveda, morphological diagnosis of Vipadika (~cracks in soles) for tinea pedis seems to be a misnomer, leading to contradictory treatments resulting in exacerbation of the disease. Thus, understanding of pathology is crucial in this condition as there is involvement of deeper pathological elements, and it is supposed to be considered as of Tridosha (~three regulatory functional factors of the body) origin. A 54-year-old female presented with a moccasin-type (hyperkeratotic) Tinea pedis as anhydrotic fissured heels. Diagnosis was made on the basis of clinical presentation and microscopic examination using KOH mounting and Lactophenol cotton blue staining. Considering the initial Dosha status of Kapha - Vata predominance in the condition, the case was managed through Ayurveda treatment protocol, including Punarnavadi kwatha and Yogaraja guggulu . The Dosha status assessed shifted to Pitta - Kapha dominance after one week of treatment, which was managed with Panchatiktaka kwatha and Yogaraja guggulu . The patient showed a significant reduction in the thickness of the plantar skin and itching. Later, normal skin texture was restored by the fifth week and maintained till the last follow-up at the end of the ninth month. The case demonstrated sustained positive outcomes in the management of Tinea pedis, with appropriate utilization of modern diagnostic methods along with judicious selection of Ayurveda treatment strategies based on Dosha assessment at different stages of the disease.