Tinea pedis, treatment with

Athlete s foot, tinea pedis, is a condition caused by a fungus. Management of athlete s foot lies with the use of antifungal preparations such as clotrimazole (an imidazole antifungal) and tolnaftate. Salicylic acid is a keratolytic agent indicated for use in treatment of corns, calluses and warts. 

Other older, less effective topical antifungal agents still available include undecyleitic acid Desenex, others). Used in the treatment of topical dermatophytes, undecyleitic acid is fungistatic, requires prolonged administration, and is associated with a high relapse rate. Desenex, containing 5% undecyleitic acid and 20% zinc undecylenate, is effective in the prevention of recurrent tinea pedis. 

Benzoic and salicylic acid ointment is known as Whitfield s ointment. It combines the fungistatic action of benzoate with the keratolytic action of salicylate. It contains benzoic acid and salicylic acid in a ratio of 2 1 (usually 6% 3%). It is used mainly in the treatment of tinea pedis. 

CTolhniazole is availabie as a solution in polyethylene ilunl 400. a lotion, and a cream in a concentration of These arc ail indicated for the treatment of tinea pedi.s. tr.i cruris, tinea capitis, tinea versicolor, or cutaneous 3diiiiasis. A 1% vaginal cream and tablets of 100 mg d II0 mg arc available for vulvovaginal candidiasis, ilttimizulc is extremely stable, with a shelf life of mote iin 5 years,... 

Data is also available suggesting efficacy of topical garlic on fungal infections. For tinea pedis, 1-week topical treatment with ajoene 1% twice daily resulted in mycological cure 60 days later in 100% of patients, compared to 94% for 1% topical terbinafine and 72% for 0.6% topical ajoene (43). Another study showed that 0.6% topical ajoene was as effective as 1% terbinafine cream, both applied twice daily for 1 week, for the treatment of tinea cruris and corposis. After 60 days, effectiveness (clinical plus mycological cure) was 73 vs 71 %,respectively (44). In addition, a0.4% cream was also shown to be effective (45). Although a topical preparation is not available commercially, it could likely be compounded. 

LedezmaE,Marcano K, Jorquera A, et al. Efficacy of ajoene in the treatment of tinea pedis a double-blind and comparative study with terbinafine. J Am Acad Dermatol 2000 43 829-832. 

Tinea pedis is the most common dermatophytoses (affecting approximately 70% of adults). It is better known as athletes foot and occurs in hot weather, with exposure to surface reservoirs (locker room floors), and with use of occlusive footwear." Treatment with topical therapy for 2 to 4 weeks often is adequate for mild infections however, severe infections or involvement of the nails requires oral therapy (see Table 118-8). Recurrence of infection occurs in up to 70% of individuals. Prolonged treatment with either topical or systemic therapy may be required." " ... 

The azoles miconazole (Micatin, others) and econazole (Spectrazole, others) and the allylamines naftifine (Naftin) and terbinafine (Lamisil, others) are effective topical agents for the treatment of localized tinea corporis and uncomplicated tinea pedis. Topical therapy with the azoles is preferred for localized cutaneous candidiasis and tinea versicolor. 

Sulconazole, an imidazole derivative with antifungal effectiveness, is used in the treatment of tinea cruris, tinea corporis, and tinea pedis caused by Trichophyton menta-grophytes, Epidermophyton floccosum, and Microspomm canis. It is also used in the treatment of tinea versicolor caused by Malassezia furfur. 

Tolnaftate is a thiocarbamate. Tolnaftate is effective in the treatment of most cutaneous mycoses caused by T. rubrum, T. mentagrophytes, T. tonsurans, E. floccosum, M. canis, M. audouinii, Microsporum gypseum, and M. furfur, but it is ineffective against Candida. In tinea pedis, the cure rate is around 80%, compared with about 95% for miconazole. Toxic or allergic reactions to tolnaftate have not been reported. 

Tolnaftate (1% cream, solution and gel) is indicated for treatment of tinea pedis (athlete s foot), t. cruris (jock itch), or t. corporis (ringworm) due to infection with Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, and Epidermophy ton floccosum, and as treatment for tinea versicolor due to Malassezia furfur. 

Figure 3. Treatment of Tinea Pedis with Socks Containing Copper Impregnated Fibres Healing of diabetic olcers...

The most common form of tinea pedis is located in the toe webs. The fourth interdigital web is preferentially infected, but the other webs can also be infected, on one or both feet. The clinical symptoms are characterised by a whitish, diffuse maceration in the cleft marginated by a collarette of continuous desquamation (Fig. 10). In some cases, there is a small, painful fissure running along the line of the cleft. The entire area is ulcerative and macerated from microbial superinfection. Itching is usually present. In T. rubrum infections, a squamous, hyperkeratotic variety that is particularly chronic and resistant to treatment and that affects the soles, heels and sides of the feet ( moccasin foot ), is often found (Hay and Moore 1998). The dorsal surfaces of the toes and feet are not often affected, but associated onychomycosis is common. Tinea pedis is sometimes associated with reactive plantar pompholyx extremely pruritic, coalescent vesicular eczema is observed. Microscopic examination sometimes reveals the presence of dermatophytic filaments in these so-called id reactions. 

For inclusion in a randomized, double-blind, controlled trial, 158 patients with the clinical features of intertriginous tinea pedis and con rmed dermatophyte infection were recruited. They were administered 25% or 50% M. alternifolia essential oil (in an ethanol and polyethylene glycol vehicle) or the vehicle alone, twice daily for 4 weeks. There was an improvement in the clinical severity score, falling by 68% and 66% in the 25% and 50% tea tree oil groups, in comparison to 41% for the placebo. There was an effective cure in the 25% and 50% tea tree oil and placebo groups of 48%, 50%, and 13%, respectively. The essential oil was less effective than standard topical treatments (Satchell et al., 2002b). 

Satchell, A. C., Saurajen, A., Bell, C., Barnetson, R. StC. 2002b. Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution A randomised, placebo-controlled, blinded si. iAy.Amti J DermMol. 45 175-178. 

Studies continued with two other topical agents for use in treatment of dermatophytoses. Tolnaftate (Tlnactln), as a 1 per cent powder, was found effective in both prevention and treatment of tinea pedis caused by Candida. Trichophyton and Epidermophyton.2 Haloprogin (Halotex), used topically as either a 1 per cent solution or as a cream, was found to be more effective than a placebo O and comparable to tolnaftate l in the treatment of experimental dermatophytlc infections (Trichophyton rubrum) and naturally occurring human Infections. 

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