Tinea pedis epidemiology and importance from the lens of homelessness and low-resource settings.

Abstract

Patients experiencing homelessness (PEH) are a patient group with high levels of morbidity and mortality. PEH have high rates of dermatophyte infections, although the exact incidence and prevalence compared to the general population has not been determined. This study characterizes tinea pedis in homeless individuals across geographic locations and offers recommendations for treatment in low-resource settings. A total of 58 PubMed articles were analyzed with inclusion criteria containing ‘tinea pedis’ and ‘homeless’. Cohort studies, cross-sectional studies, and case-control studies published from 1979–2022 were evaluated. In North America, among sheltered homeless individuals the prevalence of tinea pedis ranged from 3.2–13.5% whereas it occurs at roughly a 10% frequency in the general population. European studies showed a tinea pedis frequency of 4.4–34.9% in the general population compared to 3.2% in a homeless patient cohort. There is incomplete data on tinea pedis infections in homeless populations in Africa, Asia, and South America. There are statistically significant differences in disease burden and healthcare utilization between sheltered and unsheltered homeless patients. This study raises questions about the status of dermatophytosis among homeless populations in high-risk areas such as the Southern United States. Pre-emptive treatment of tinea pedis is vital for PEH due to the potential for severe complications such as cellulitis and osteomyelitis. Longitudinal treatment in low-resource settings with simple interventions such as antifungal powder, socks, and hygiene supplies, can potentially prevent the progression of tinea pedis and improve disease burden.