Can Ciclopirox Shampoo Help Combat Fungal Infections Of The Feet?

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By Gary L. Dockery, DPM, FACFAS

Serious foot infections result from a combination of factors including disease, injury, neuropathy, vascular impairment and insufficient wound healing. Diabetic patients, in particular, are at high risk of developing serious complications in lower extremities that can lead to amputation. Of the estimated 17 million people who have Type 1 and Type 2 diabetes, almost 15 percent will undergo lower extremity amputation during their lifetime.1,2 Approximately 80 percent of diabetes-related amputations are preceded by chronic foot ulcers.3-5 Many chronic foot ulcers in diabetics are the result of lower extremity infections. In addition to patients with diabetes, immunocompromised patients and those who have peripheral vascular disease frequently suffer lower extremity complications because of fungal and bacterial infections. Fungal infections of the skin and nails are commonly seen as the underlying basis for tinea pedis and other fungal and bacterial infections.6 Approximately 30 percent of patients with diabetes have disease-related dermatologic problems.7 Fungal and bacterial infections, as well as candidiasis, most often occur as opportunistic or secondary infections in patients who are already compromised or susceptible to infection. One of the most common fungal infections we see is tinea pedis.8 More common in adolescents and adults than in children, this superficial skin infection typically involves the interdigital spaces and may present as dermatophytosis simplex or dermatophytosis complex with a possible secondary bacterial infection.9-11 We also see quite a bit of chronic paronychia, onycholysis and onychomycosis, common dermatological nail disorders that require a comprehensive and prophylactic management approach to arrive at optimal clinical outcomes and reduce the risk of chronic presentation.12,13 Although nail infections are preceded by a dermatophyte, the symptomatic patient may have a more complex infection that may be complicated by pyogenic bacteria or other fungal species.7 What About Using A Shampoo As A Preventive Foot Wash? One novel approach for treating tinea pedis and other fungal and bacterial infections is using ciclopirox in the shampoo formula as a foot wash to curb infection and using it prophylactically as well to prevent recurrence. I have used the shampoo as a foot wash in a clinical setting, both as part of a treatment regimen and prophylactically. Although there are no good studies to prove the specific effectiveness of Loprox® (ciclopirox) Shampoo as a foot wash, some authors have concluded that ciclopirox in the shampoo formula makes an effective foot wash if it is used daily, and it appears to decrease the chance of relapse and reinfection after one treats tinea pedis topically.14 Anecdotally, I have found that foot infections resulting from fungal and bacterial pathogens can be effectively controlled with ciclopirox shampoo. The process involves having the patient put a small amount of the shampoo on both feet and washing the lower leg and foot completely. Patients may do this at the beginning of a shower or at the end. They should rub in the shampoo with a small amount of water, leave the shampoo lather on for a few minutes and then rinse it off. There are alternatives for patients who may have difficulty reaching their feet in the shower. One option is to use a soft-bristled back brush with a small amount of shampoo to wash both feet. Another option is to telling the patient to sit in an empty tub, wet his or her feet and then wash them with the shampoo as described. After a few minutes, the patient can rinse off the shampoo and dry his or her feet before leaving the tub. Patients should repeat this process daily in order to prevent the recurrence of bacterial and fungal foot infections. Recommendations for reducing the incidence of reinfection by fungal or bacterial pathogens include: bathing daily and drying feet well between the toes; wearing socks that absorb moisture and wick it away from the skin; changing shoes daily; wearing sandals or shoes that allow air to circulate; and using antifungal and antibacterial agents to prevent recurrence.15,16 According to Gupta, et.

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