Can Ciclopirox Shampoo Help Combat Fungal Infections Of The Feet?

By Gary L. Dockery, DPM, FACFAS
al., ciclopirox offers advantages in treating tinea pedis with its antifungal, antibacterial, and antiinflammatory properties.10,11 In a double-blind, randomized, vehicle controlled study by Aly et. al., they found daily use of ciclopirox gel for four weeks effective and safe for treating moderate to severe tinea pedis interdigitalis.17 Ciclopirox in gel formula is indicated for the treatment of interdigital tinea pedis as well as seborrheic dermatitis of the scalp and tinea corporis.18 In addition to addressing issues of chronic nail trauma and avoiding irritants associated with paronychia and onycholysis, eliminating possible exacerbating pathogenic fungi with a broad-spectrum antifungal agent has been associated with positive treatment outcomes.19 Taking A Closer Look At Ciclopirox And Its Mechanism Of Action Ciclopirox (Loprox) is currently indicated for topical treatment of a broad range of dermal fungal infections including: tinea pedis, tinea cruris, and tinea corporis due to Trichophyton rubrum, T. mentagrophytes, Epidermophyton floccosum, and Microsporum canis. It is also indicated for candidiasis due to Candida albicans and tinea versicolor due to Malassezia furfur.18 Ciclopirox also has in vitro activity against many gram positive and gram negative bacteria including Proteus species, Pseudomonas species, Proprionibacteria acnes, and Cornybacterium minutissimum.20 Researchers have also shown that ciclopirox may exhibit better antiinflammatory activity than 2.5% hydrocortisone.21 Ciclopirox is a synthetic, broad-spectrum hydroxypyridone antifungal, antibacterial and antiinflammatory agent that differs chemically and mechanistically from other antifungal drugs in the azoles and allylamine classes.21-24 Ciclopirox kills fungi via chelation of polyvalent cations and inhibition of metal dependent enzymes, including those responsible for degradation of peroxides.22-24 Other antimycotics only alter steps in the sterol biosynthesis of fungal membrane. Ciclopirox primarily affects iron-dependent enzyme systems such as cytochromes, catalase and peroxidase. It also impairs the activity on mitochondrial hemoproteins by binding with iron, thus killing the cell organism. Ciclopirox affects the cytoplasmic membrane as well as it appears to impair active transport mechanisms, cell respiratory processes and membrane integrity. It also negatively influences the macromolecular synthesis of nucleic acids and proteins.21-24 Ciclopirox’s antifungal, antibacterial and antiinflammatory effects suggest a strong proclivity for daily prophylaxis use by patients susceptible to fungal and bacterial infections that can lead to decreased significant lower extremity problems. Using the shampoo as a foot and lower leg wash has several advantages including the fact that it is an ideal topical broad-spectrum agent, which is very efficacious in low concentrations. It is both keratinophilic and lipophilic, allowing for better penetration and fungicidal activity. There is a reservoir effect in the stratum corneum, resulting in high mycologic and clinical cure rates, a lack of microbial resistance, a very low relapse rate and a low overall incidence of adverse effects.25 Clinically, ciclopirox demonstrates powerful antifungal activity.21,24 Researchers have shown that a 1% preparation of ciclopirox penetrates all layers of the stratum corneum of human skin and inhibits the growth of Trichophyton mentagrophytes. It also has proven in vitro fungicidal activity against Trichophyton rubrum, Epidermophyton floccosum, Candida albicans, and Microsporum canis.26 In Conclusion Therefore, it is reasonable to propose that ciclopirox’s antifungal, anti-inflammatory and antibacterial properties can reduce the number of foot infections by inhibiting potential pathogen colonization and reducing the likelihood of their recurrence in patients with diabetes. As the number of people who constitute “at-risk” population increases, fungal and bacterial skin infections will rapidly increase and impact the pharmacoeconomic concern of health care.31 Early recognition and treatment of lower extremity problems will help prevent direct morbidity and other complications.

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