Dos and Don’ts for Foot Fungus
Tinea Pedis
In WV, we are approaching fall. That means we have lived the past few months outside, barefoot, poolside, lakeside, on a boat. All great places to pick up foot fungus. So, before you put your feet to rest in your boots for fall and winter, let’s get that foot fungus cleared up!
The fancy name for foot fungus is Tinea pedis. Fungus in the toenails is called tinea unguium. The common word here is “tinea” which in dermatology generally describes an infection of the skin, hair or nails with fungus. There are multiple types of fungus, but the types that affect the outer layer of the skin are generally classified as dermatophytes. Dermatophytes generally only live in the epidermis, the outer layer of the skin. However, under some conditions, they can be forced or allowed to grow a little deeper making them stubborn to treat.
DO! Use a topical antifungal. Generally, there are two types of antifungals-Fungistatic and Fungicidal. Fungistatic topicals SLOW DOWN the growth of fungus only. Fungicidal topicals actually KILL fungus. Doesn’t take an MD Ph.D. like me to make a choice. KILL the fungus. However, you probably will be surprised to find that only a few antifungal topicals are actually fungicidal. In OTC products, only Lamisil ( generic terbinafine) is fungicidal. No wonder patients often treat their fungus for years with no success. Use Lamisil cream ( or its generic equivalent) every day one week past when you think your skin is normal. I’ll reference a real scientific article about topical antifungals here for all you “budding” mycologists. Pardon my nerdy joke. A Mycologist is the type of scientist who studies fungus and yeast, some of which have “budding” subtypes.
DON’T! Ever, ever, ever use a topical steroid. Generally, fungus only lives on the surface of the skin in the epidermis. However, if a topical steroid is applied to fungus, it grows like wildfire and allows the fungus to penetrate into the hair follicles and deeper in the skin where they are often impossible to treat with topicals alone. The name for the type of fungal infection that occurs after a topical steroid is used is Majocchi’s granuloma. We have an old article about this that I’ll link below. Once the fungus has been treated with a topical steroid, an oral antifungal, such as terbinafine, is required for 2-4 weeks to clear the infection. Again, it is important to pick a fungiCIDAL oral medication.
DO! Keep the area prone to fungus clean and dry. Purposely use a foot brush on your feet, toenails and make sure you wash between your fourth and fifth toes. Between the fourth and fifth toes is the most common location where foot fungus occurs on the feet. For foot powders, I recommend Zeasorb AF powder. It is very absorbent and is fungistatic. Lamisil also makes a new “spray powder” that would be fungicidal.
DON’T forget your nails. Nail fungus can be a repeated source of contamination. Patients clear the foot fungus but get reinfected by their own fungus infected toenails. Some patients scratch with fungus infected fingernails as well. Oral Lamisil (generic terbinafine) is used to treat nail fungus. 3 months for fingernails, and 6 months for toenails.
DO! Wear socks and clean your shoes often. Particularly flip flops and sandals. I wash them in the washing machine and put them out in the sun to dry. While I don’t think there’s a scientific study on this, one of my wise elder professors said to put shoes in a garbage bag and tie them up for a month. If they still smell bad after a month, he said there’s no hope for decontaminating the fungus.
Well, I hope this helps. Part of my goal with these articles is to give patients the information they need to treat properly at home. That way, I can focus my efforts on what requires prescription medication in the office. Share this with you friends and family who you think can benefit. Who doesn’t have a little foot fungus from time to time?
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