Topical treatment for moccasin-type tinea pedis

Sixty patients were treated for tinea pedis with 2% topical ketoconazole cream either once or twice daily. All diagnoses were confirmed mycologically. They were randomly assigned in a double-blind study into three groups on the basis of their clinical lesions, that is, vesicular pedis, interdigital pedis, and hyperkeratotic "moccasin" pedis. Patients were treated for a period of 1 month and were evaluated weekly. A 4-week posttreatment evaluation permitted an assessment of recurrence or improvement. The follow-up visits showed 93% of the vesicular patients, 86% of the interdigital patients, and 83% of the moccasin patients had responded to topical ketoconazole therapy. The high percent of clinical efficacy seen in the first two groups corroborates treatment experiences held by most practicing dermatologists. Of practical interest, however, was the high number of responders among the moccasin-type of tinea pedis. Dermatologists rarely consider topical treatment useful for this clinical entity.