Can Ciclopirox Shampoo Help Combat Fungal Infections Of The Feet?
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
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. Given its antifungal, antibacterial and antiinflammatory properties, ciclopirox shampoo may be used as an ancillary therapy to control pathogens and help promote rapid healing.15,19,22,27 Using the shampoo formulation of ciclopirox as a specific foot wash treatment regimen and prophylacticaly could have a significant impact on reducing morbidity in specific populations and reducing complications.
Dr. Dockery is a Fellow of the American Society of Podiatric Dermatology and the American College of Foot and Ankle Surgeons. He is the Founder and Director of Scientific Affairs of the Northwest Podiatric Foundation Education and Research, USA in Seattle.
Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.
1. American Diabetes Association: Diabetes Facts: The Dangerous Toll of Diabetes. Alexandria, Virginia. 1996.
2. Reiber GE, Boyko EJ, Smith DG: Lower extremity foot ulcers and amputations in diabetes. Diabetes in America, 2nd Edition. Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, eds. U.S. Government Printing Office. Washington, DC,1995:409-428.
3. Armstrong DG: Is diabetic foot care efficacious or cost effective? Ostomy Wound Manage. 2001;47(4):28-32.
4. Grunfeld C: Diabetic foot ulcers: etiology, treatment, and prevention. Adv Intern Med. 1991;37:103-132.