[Antimycotic therapy of Tinea pedis and other foot mycoses]

Fungal foot infections belong to the most frequent infectious diseases in industrialized countries. In Germany, an estimated one third of the total adult population is suffering from a mycosis of the foot. In most cases, these infections are caused by a dermatophyte species, especially Trichophyton rubrum and T. mentagrophytes, and affect the toes and the areas between the toes, respectively, and/or the soles of the foot (Tinea pedis). In some cases, foot infections due to other fungi than dermatophytes (predominantly Candida spp.) have been described. Based on underlying symptoms and localization of the infection, there are three principal forms of foot mycoses. The most common type is the intertriginous type characterized by peeling, maceration and fissuring mostly affecting the lateral toe clefts. The rarer vesiculobullous form is characterized by vesicles and blisters often located on the soles. The squamous hyperkeratotic form, referred to as moccasin type in its extensive form, affects the soles, heels and lateral sites. If there is no extensive spread of infection, intertriginous and vesiculobullous forms can be generally successfully treated with topical antimycotics. The squamous hyperkeratotic form, however, should be treated by simultaneous application of topical and systemic antifungals. Because of the prescription discharge of a range of topical antimycotics, the advisory function of pharmacists is vitally important. In Germany, self-medication with "over the counter" antifungals is carried out using a range of different topical agents, in particular several azole derivatives and the allylamine terbinafine. The allylamine naftifine, the morpholine amorolfine and the pyridinone derivative ciclopiroxolamine are also applied. For systemic treatment, systemically applicable azole antifungals (fluconazole, itraconazole), terbinafine and griseofulvine are in use.