14/11/2019
👣 WHAT YOU NEED TO KNOW ABOUT FUNGAL FOOT INFECTIONS 👣
Fungal foot infections (FFI) are the most common infections on the foot we see in our clinical practice.
Fungi can live in the air, soil, water, and plants. There are also some fungi that live naturally in the human body.
Like many microbes, there are helpful fungi and harmful fungi. When harmful fungi invade the body, they can be difficult to kill, as they can survive in the environment and re-infect the person trying to get better.
Fungus quite often affects the nails and can cause significant discoloration. Nails that have been damaged are particularly susceptible to fungal invasion. It can also affect the skin causing visible skin changes, redness, and itching.
DIAGNOSIS OF FUNGAL FOOT INFECTION
There are a few ways to test for presence of fungal spores.
Dermatophyte Test Strip (DTS) is a simple & accurate way and shows results in just 5 minutes. It can be performed as part of your FHP treatment and offers a very reliable diagnosis. This will enable you to start the right antifungal treatment immediately without having to send clippings to an external laboratory. Your GP will also be informed of the results, as systemic medication may be needed.
WHAT YOU NEED TO KNOW ABOUT FUNGAL FOOT INFECTIONSTREATMENTS IN FUNGAL FOOT INFECTION
Treatment for fungal foot infections will depend on the type, severity, medical history of the patient and age. Anyone with a weakened immune system may be more likely to contract a fungal infection, as well as anyone who is taking antibiotics. Cancer treatment and Diabetes can also make a person more prone to fungal infections.
Most fungal skin infections can be treated with over-the-counter or prescription creams. Severe infections may require additional methods.
TOPICAL AGENTS FOR TINEA PEDIS (SKIN INFECTION)
Tinea pedis is a condition that generally responds to topical antifungal agents.
Most formulations are available in the clinic as well as in the chemist.
These include Canesten, Dactarin, Dactarin Gold, Grisol, Mycota, Lamisil and Mycil.
KEY POINT
Topical Terbinafine (Lamisil) has been shown to be equally effective for treating tinea pedis in all its forms, such as a spray, cream and film-forming solution.
Based on the available evidence to date, older preparations such as Whitfield’s ointment (benzoic and salicylic acid) are probably less effective than azoles and terbinafine. Tea tree oil (Melaleuca) and Vicks remain a popular over-the-counter treatment but can cause skin irritation.
KEY POINT
The use of tea tree oil and Vicks in the treatment of onychomycosis is not recommended by National Institute for Health and Care Excellence (NICE) guidelines.
WHAT YOU NEED TO KNOW ABOUT FUNGAL FOOT INFECTIONS:
ONYCHOMYCOSIS – NAIL FUNGAL INFECTION
When onychomycosis is considered to be mild to moderate, topical agents can be considered. Treatment requires good compliance as it can take 12-18 months. Studies have proven that the delivery of topical drugs to the infected nail can be enhanced by reducing the nail on a regular basis.
Amorolfine 5%, Curanail 3% are nail lacquers that inhibit the growth on fungus.
Mykored , Excilor and Emtrix create a nail environment in which the fungus finds it difficult to grow, therefore they help the appearance of the nail.
KEY POINT
Nail reduction prior to antifungal treatment in onychomycosis improves the cure rate.
SYSTEMIC MEDICATION
If the infection is severe, affecting majority of the surface of the nail and the nail root, oral medication can be prescribed by your G.P.
KEY POINT
Any patient receiving systemic antifungal agents should first have the infection confirmed to prevent prescribing errors.
FENESTRATION OF THE NAIL (LACUNA METHOD)
Most topical agents are ineffective at penetrating the nail plate to reach the active infection on the nail bed (the skin under the nail).
By making micro holes in the nail plate enables the anti-fungal agent, such as Lamisil spray, to be absorbed directly to the infected nail bed.
The Lamisil Spray will spread under the nail as you walk and with daily application the fungus is stopped from spreading and the damaged nail grows out.
KEY POINT
Current evidence has shown many significant benefits of fenestration in the treatment of onychomycosis.
Laser devices emit pulses of energy that impart heat to tissues that it contacts. The effect of the laser on fungal nails relies on the fungal cells absorbing this heat, which kills the microbe.
The laser energy pe*****tes through the toenail, to the nail bed beneath where the fungus is likely also present. This ability to pe*****te the full thickness of the toenail is probably what leads to the promising results seen thus far with laser treatment. However, current evidence is very limited as this is a new management method.
KEY POINT
The cost of receiving laser treatment for onychomycosis as well as the limited evidence of its effectiveness make it less favourable amongst patients.
