Treating Tinea Pedis In Patients With Diabetes
Combination therapy is often recommended for people with diabetes as it theoretically reduces the length of treatment time and minimizes the risk of side effects. There is greater antifungal activity and therefore, treatment time is theoretically shorter. This is particularly beneficial for people with diabetes who are likely to have molds and yeasts as well as dermatophytes responsible for their tinea pedis and/or onychomycosis.
Furthermore, when it comes to combination therapy, the dose required of individual antifungal agents is reduced, thereby minimizing the potential for side effects and drug interactions. Another hypothetical benefit of combination therapy is that the use of a topical antifungal nail lacquer would encourage regular foot inspection, thereby reducing the risk of ulceration.5
Strategies For Tinea Pedis Prevention
Given the risks associated with these infections and the difficulties of treatment, prevention is important for people with diabetes. Since tinea pedis is contagious, thrives in moist, dark environments and spreads by direct contact, people should ensure that their feet are clean and dry, and avoid coming in direct contact with the infectious organisms. Accordingly, clinicians should emphasize the following prevention strategies for patients.
• Ensure feet are thoroughly dry after having a shower.
• Wear clean, absorbent socks made of natural fibers, such as cotton, and change them during the day if feet become moist and/or sweaty.
• Keep shoes dry. There are a number of ways to achieve this. People can remove shoe insoles overnight to allow them to dry and alternate wearing different pairs of shoes to allow them to dry out for a day or two at a time.
• Avoid direct contact with the fungal organism. Wear sandals in public locker rooms and swimming areas. Do not wear someone else’s shoes, especially if that person has tinea pedis.
• Elevated blood sugar levels also encourage the development of tinea pedis. Controlling blood sugar levels will therefore assist in the prevention of this infection.
While the evidence base for treatment interventions for tinea pedis has made great progress over the years, there is still a need for further research that examines treatment interventions in people with diabetes. At present, there are no studies to our knowledge that examine the safety and/or efficacy of medications for tinea pedis in people with diabetes (that fit the criteria of our review).
Furthermore, while a number of different treatment interventions have been examined for onychomycosis in people with diabetes, these interventions represent a very small proportion of the possible treatment options available. Research that examines the safety and efficacy of other possible treatment modalities (such as combination therapy, mechanical debridement, herbal therapy and light therapy) are needed.
Perhaps most importantly, efforts are needed to reduce the length of treatment time for people with diabetes. Current evidence suggests that approximately 48 weeks after the commencement of treatment, complete cure rates for tinea pedis vary between 7.7 and 52.9 percent.31 This is a significant length of time to be at an increased risk of complications and a significant number of people are not cured despite enduring treatment and possible side effects.
Ms. Matricciani is a researcher at the University of South Australia School of Health Sciences.
Dr. Jones is the Program Director of Podiatry at the University of South Australia School of Health Sciences.