AT THE SOUTH BEACH SYMPOSIUM
MIAMI BEACH (FRONTLINE MEDICAL NEWS) – Two new antifungal agents on the market – luliconazole and naftifine – each have something unique to offer when it comes to treating tinea pedis, according to Dr. Boni E. Elewski.
Luliconazole is an azole drug, meaning it is broad spectrum and kills dermatophytes, yeast, and molds. Also, like all azoles, it has some antibacterial activity, she said at the South Beach Symposium.
Naftifine is an allylamine drug, and is mainly an antidermatophyte agent – albeit a “very, very potent antidermatophyte” – with no antibacterial activity, she said.
Both are approved for once-daily use for 2 weeks, and that’s good because the short treatment duration improves adherence to the regimen, especially compared with other drugs that require 4-6 weeks of treatment to eradicate the problem, noted Dr. Elewski, professor of dermatology and director of clinical trials research at the University of Alabama at Birmingham.
Both drugs also stay in the skin and continue working after treatment stops.
Making the choice regarding which drug or class of drugs to use depends on the patient’s symptoms.
“First of all, tinea pedis may not be obvious. People don’t often tell you, ‘This is what I have – it’s tinea pedis,’ ” she said.
Keep in mind that tinea pedis and onychomycosis are related. If you have a patient who you think has onychomycosis, look at the bottom of their foot, she advised.
“If they don’t have tinea pedis, they probably don’t have onychomycosis unless they’ve had tinea pedis recently and got rid of it,” she said.
Also, look for collarettes of scale, which may be very subtle and may look like “tiny little circular pieces of scale on the medial or lateral foot.”
“If you are not sure, just keep looking harder because you might see it,” Dr. Elewski said.
Interdigital tinea pedis will be a little more obvious, with scaling and crusting between the toes, as well as maceration and oozing in many cases.
When the toe web is oozing, you’re likely dealing with intertrigo, she said.
In such cases, an azole cream is the better treatment choice, because azoles will kill Candida, bacteria, and dermatophytes that are there, she said.
“So when I have a moist macerated space, I like an azole. If you have a dry scaly process – with or without the collarettes – you’re probably better with an allylamine, particularly if you use a keratolytic with it, something that has urea or a lactic acid,” she said.
Dr. Elewski is a consultant for Valeant Pharmaceuticals International and a contracted researcher for Anacor Pharmaceuticals.
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