Current And Emerging Agents For Tinea Pedis

Tracey Vlahovic, DPM, FFPM RCPS (Glasg)

How Socks Can Help And Hinder Patients With Tinea Pedis

Although topical medications are the mainstay of treatment, recent evidence shows that socks can both hinder and help patients who have tinea pedis. Out of the many reasons for recurrence after treating tinea, Bonifaz and colleagues theorized that fomites, like the patient’s own socks, are a source of re-infection.12 Research has shown that T. rubrum can survive in fabrics washed at 30º C but are inactive at 60º C.13 In order to study the viability of dermatophytes in the socks of patients who have both tinea and onychomycosis, Bonifaz and colleagues asked 86 patients with culture positive disease to bring in a pair of used, washed socks. In a controlled environment, researchers took swabs for culture of the socks directly and made serial dilutions of the socks to determine the extent of dermatophyte isolation.

   According to the study results, dermatophytes can survive in socks after washing and 10.46 percent of patients were at risk for re-infection by having contact with their socks.13 Ultimately, through both direct isolation and isolation from the serial dilutions, the authors showed that dermatophytes can survive in textiles. The study didn’t delve into the possibility of what using bleach or multiple washes would do to dermatophyte viability, but hopefully that will be the grounds for another project.

   In contrast, socks impregnated with copper oxide particles have shown promise in the possible treatment and management of those with pedal fungal infections in a most unlikely and unfortunate situation. In August 2010, a mine collapse trapped 33 Chilean miners underground for 69 days.14 After being underground for two weeks, the miners experienced and complained of pedal skin issues that were most likely secondary to the harsh conditions: 85 percent humidity and greater than 93º F in temperature. Rescuers delivered tubes of clotrimazole to the miners but the medication did not provide any resolution.

   Rescuers also delivered three pairs of copper oxide infused socks (Cupron socks, Cupron, Inc.) to the miners after they had been trapped for 30 days.14 Researchers have documented the fungicidal and antimicrobial properties of copper oxide.15 Once rescued, the miners reported that their skin condition improved after wearing the socks for four to seven days and only one rescued miner had tinea pedis despite being exposed to the severe conditions underground. Of course, this was not a controlled research study but the results certainly warrant further research and the use of this product on those who are plagued by tinea pedis both consistently and occupationally.

   Recurrence due to close contact of continually infected textiles is not only limited to sock use. Shoes are also a constant reservoir for fungus and bacteria. Besides data from Tanaka and coworkers showing that washing sneakers (but not boots) in boiling or cold water was useful in eradicating dermatophytes, some physicians have recommended spraying footwear with various household disinfectants that ultimately might not be shoe- or skin-friendly.16

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