Diagnosis and Treatment of Tinea Pedis (Fungal foot infection)

Journal of Fungi: A Systematic Review of Randomized Controlled Trials

Tinea pedis, or athlete’s foot, is a superficial fungal infection of the skin of the feet caused by dermatophytes, most commonly Trichophyton rubrum, Trichophyton mentagrophyte and Epidermophyton floccosum.

Tinea pedis is common worldwide, with more than 70% of the population experiencing this infection during their lifetime. Tinea pedis onychomycosis is more prevalent in older people. Some groups are more at risk of dermatophyte infection due to occlusive footwear, sweating, and barefoot contact, such as farmers, day labors, miners, soldiers, and marathon runners.

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Key Points:

Diagnosis is confirmed by the detection of segmented hyphae in skin scrapings using a potassium hydroxide (KOH) preparation and fungal culture from these skin flakes. Increasingly rapid real-time diagnostic polymerase chain reaction (PCR) is being used, which can prove helpful in cases of recurrence of infection.

Preventative adjunct treatment strategies include ensuring that the interdigital spaces remain dry, wearing well-ventilated shoes and socks composed of natural fibres, and covering feet when using communal facilities.

The 2 major classes that represent the majority of available topical antifungal agents are the azoles and the allylamines. Another class is topical benzylamines (butenafine) are sometimes classified as a subset of allylamines.

Overall, the allylamines (ie, terbinafine) are superior to the azoles (ie, ketoconazole, miconazole, clotrimazole, econazole etc), in activity against dermatophytes, although both are clinically effective.

Topical terbinafine and butenafine treatments of tinea pedis were more efficacious than placebo. Tableted terbinafine and itraconazole administered orally were efficacious in the drug treatment of tinea pedis fungal infection. Tablet terbinafine is superior over itraconazole.

Tinea pedis may require treatment for 4 weeks. Treatment should continue for at least one week after symptoms have resolved.

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Abstract

Objective:

To systematically review literature enabling the comparison of the efficacy of pharmaceutical treatments for tinea pedis in adults.

Design:

Systematic review of randomised controlled trials (RCTs) with mycological cure as the primary outcome. Secondary outcomes did include the clinical assessment of resolving infection or symptoms, duration of treatment, adverse events, adherence, and recurrence.

Eligibility Criteria:

Study participants suffering from only tinea pedis that were treated with a pharmaceutical treatment. The study must have been conducted using an RCT study design and recording age of the participant > 16 years of age.

Results:

A total of seven studies met the inclusion criteria, involving 1042 participants. The likelihood of resolution in study participants treated with terbinafine was RR 3.9 (95%) times those with a placebo. Similarly, the allylamine butenafine was effective by RR 5.3 (95%) compared to a placebo. Butenafine was similarly efficacious to terbinafine RR 1.3 (95%). Terbinafine was marginally more efficacious than itraconazole, RR 1.3 (95%).

Summary/Conclusion:

Topical terbinafine and butenafine treatments of tinea pedis were more efficacious than placebo.

Tableted terbinafine and itraconazole administered orally were efficacious in the drug treatment of tinea pedis fungal infection.

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