Home' Australian Pharmacist : August 2011 Contents Vol.30–August#08
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
evidence in patient care
suggest that the combination of
oral terbinafine and amorolfine
may be more effective than oral
Fungal foot infections are common,
particularly in older children and
adults. Pharmacists can assist
patients in the prevention and
management of tinea pedis by taking
an adequate patient history, examining
the feet if possible and providing
appropriate advice. If infections are
severe, widespread or recurrent,
or if nail involvement is suspected,
patients should be referred. In the
case described at the beginning of
the article, John is likely to have
interdigital tinea pedis. He should be
informed that while topical tolnaftate
is effective compared to placebo,
it is considered less effective than
other treatment options and requires
treatment for around 3–4 weeks.
He may prefer a treatment that acts
more rapidly and is more effective,
such as terbinafine. Verbal and
written advice on personal hygiene,
as an important adjunct to antifungal
treatment and for preventing
recurrence, should be provided.
1. Merlin K, Kilkenny M, Plunkett A, et al. The prevalence
of common skin conditions in Australian school
students: 4. Tinea pedis. Br J Dermatol. 1999; 140:897–
2. Gentles J, Evans E. Foot infections in swimming baths.
BMJ. 1973; 3:260–2.
3. Evans E. The rationale for combination therapy. Br J
Dermatol. 2001; 145 Suppl 60:9–13.
4. Noble S, Forbes R, Stamm P. Diagnosis and
management of common tinea infections. Am Fam
Physician. 1998; 58:163–74,177–86.
5. Gupta A, Ricci M. Diagnosing onychomycosis.
Dermatologic Clinics. 2006; 24:365–9 .
6. Vander Straten M, Hossain M, Ghannoum M.
Cutaneous infections dermatophytosis, onychomycosis,
and tinea versicolor. Infectious Disease Clinics of North
America. 2003; 17:87–112.
7. Sumikawa M, Egawa T, Honda I, et al. Effects of foot
care intervention including nail drilling combined with
topical antifungal application in diabetic patients with
onychomycosis. J Dermatol. 2007; 34:456–64.
8. Roseeuw D. Achilles foot screening project: preliminary
results of patients screened by dermatologists. J
Eur Acad Dermatol Venereol. 1999; 12 Suppl 1:S6-9;
9. Djeridane A, Djeridane Y, Ammar-Khodja A.
Epidemiological and aetiological study on tinea pedis
and onychomycosis in Algeria. Mycoses. 2006; 49:190–
10. Tan J, Joseph W. Common fungal infections of the
feet in patients with diabetes mellitus. Drugs & Aging.
11. Coloe S, Baird R. Dermatophyte infections in
Melbourne: Trends from 1961/64 to 2008/09. Australas
J Dermatol. 2010; 51:258–62.
12. Hainer B. Dermatophyte infections. Am Fam Physician.
13. Andrews M, Burns M. Common tinea infections in
children. Am Fam Physician. 2008; 77:1415–20.
14. Therapeutic Guidelines. eTG Complete. Melbourne:
Therapeutic Guidelines; 2011.
15. Kilkenny M, Stathakis V, Jolley D, et al. Maryborough
skin health survey: prevalence and sources of advice for
skin conditions. Australas J Dermatol. 1998; 39:233–7 .
16. Svejgaard E, Christophersen J, Jelsdorf HM. Tinea
pedis and erythrasma in Danish recruits. Clinical signs,
prevalence, incidence, and correlation to atopy. J Am
Acad Dermatol. 1986; 14:993–9.
17. English M, Gibson M, Warin R. Studies in the
epidemiology of tinea pedis. VI. Tinea pedis in a boy’s
boarding-school. BMJ. 1961; 1:1083–6 .
18. Belimgotov M. [Some data on the incidence of
epidermophytosis of the foot among children in the
North Ossetian Autonomous Soviet Socialist Republic].
Vestnik dermatologii i venerologii. 1968; 42:58–61.
19. Plunkett A, Merlin K, Gill D, et al. The frequency
of common nonmalignant skin conditions in adults
in central Victoria, Australia. Int J Dermatol. 1999;
20. Elewski B. Onychomycosis. Treatment, quality of life,
and economic issues. Am J Clin Dermatol. 2000;
21. de Berker D. Clinical practice. Fungal nail disease.
NEJM. 2009; 360:2108–16.
22. Gupta A, Ryder J, Baran R, et al. Non-dermatophyte
onychomycosis. Dermatologic clinics. 2003; 21:257–68.
23. Foster K, Ghannoum M, Elewski B. Epidemiologic
surveillance of cutaneous fungal infection in the United
States from 1999 to 2002. J Am Acad Dermatol. 2004;
24. Szepietowski J, Reich A, Garlowska E, et al. Factors
influencing coexistence of toenail onychomycosis with
tinea pedis and other dermatomycoses: a survey of
2761 patients. Arch Dermatol. 2006; 142:1279–84.
25. Elewski B, Charif M. Prevalence of onychomycosis
in patients attending a dermatology clinic in
northeastern Ohio for other conditions. Arch Dermatol.
26. Ghannoum M, Hajjeh R, Scher R, et al. A large-scale
North American study of fungal isolates from nails: the
frequency of onychomycosis, fungal distribution, and
antifungal susceptibility patterns. J Am Acad Dermatol.
27. Crawford F. Athlete’s Foot. BMJ Clinical Evidence
Online. 2009; 7.
28. Crawford F, Hollis S. Topical treatments for fungal
infections of the skin and nails of the foot. Cochrane
29. Australian Medicines Handbook. Adelaide: AMH; 2011.
30. Shear N, Einarson T, Arikian S, et al.
Pharmacoeconomic analysis of topical treatments for
tinea infections. Int J Dermatol. 1998; 37:64–71.
31. Ortonne J, Korting H, Viguie-Vallanet C, et al. Efficacy
and safety of a new single-dose terbinafine 1%
formulation in patients with tinea pedis (athlete’s foot):
a randomized, double-blind, placebo-controlled study. J
Eur Acad Dermatol Venereol. 2006; 20:1307–13.
32. Erbagci Z. Topical therapy for dermatophytoses: should
corticosteroids be included? Am J Clin Dermatol. 2004;
33. Gupta A, Ryder J, Baran R. The use of topical therapies
to treat onychomycosis. Dermatologic clinics. 2003;
34. Baran R, Sigurgeirsson B, de Berker D, et al. A
multicentre, randomized, controlled study of the
efficacy, safety and cost-effectiveness of a combination
therapy with amorolfine nail lacquer and oral
terbinafine compared with oral terbinafine alone for the
treatment of onychomycosis with matrix involvement.
Br J Dermatol. 2007; 157:149–57.
1. Which ONE of the following
dermatophytes is the most
widely distributed in man?
a) T. rubrum.
b) T. interdigitale.
c) T. mentagrophytes.
d) M. audouinii.
2. Onychomycosis is most
commonly caused by:
c) non-dermatophyte fungi.
3. The prevalence of tinea
pedis in Australian adults is
estimated to be:
4. Which ONE of the following
topical treatments was shown
to be the most effective for
interdigital tinea pedis in a
recent Cochrane review?
A score of 4 out of 5 attracts 1 CPD credit.
5. Which ONE of the following
onychomycosis is FALSE?
a) Tinea unguium is associated with
tinea pedis in approximately one-
third of cases.
b) Toenails are more commonly
affected than fingernails.
c) Superficial white onychomycosis
is not responsive to topical
d) Systemic antifungal therapy
is generally required for distal
subungal onychomycosis and total
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