What is the treatment for interdigital (between the toes) cysts or furuncles (abscesses)?

From the Guidelines

Treatment for interdigital cysts should prioritize addressing the underlying cause, such as fissuring, scaling, or maceration in the interdigital toe spaces, to reduce the incidence of recurrent infection, as recommended by the Infectious Diseases Society of America 1. When managing interdigital cysts, it's essential to consider the potential for bacterial or fungal infections in the webbed spaces between toes.

• For mild cases, daily foot soaks in warm water with Epsom salt for 5-10 minutes, followed by thorough drying between the toes, can help alleviate symptoms.
• Topical antibiotics like mupirocin or clindamycin applied 2-3 times daily for 7-10 days can be used if infection is present, as they are active against streptococci, a common cause of skin and soft tissue infections 1.
• In cases with systemic signs of infection, oral antibiotics such as cephalexin or clindamycin may be necessary, with the recommended duration of antimicrobial therapy being at least 5 days, but extended if the infection has not improved within this time period 1.
• Corticosteroid injections directly into the cyst can reduce inflammation, though this should be performed by a healthcare provider.
• Surgical drainage or excision is reserved for recurrent or treatment-resistant cysts. To prevent recurrence, it's crucial to keep the area dry, wear moisture-wicking socks, use antifungal powder between toes, and choose properly fitting shoes, as these measures can help eradicate colonization with pathogens and reduce the incidence of recurrent infection 1.

From the Research

Treatment Options for Interdigital Cysts

• Surgical treatment is considered the most effective option, with a high cure rate of 95% 2
• Other treatment options include:
  • Sclerotherapy, with a cure rate of 77% 2
  • Cryotherapy, with a cure rate of 72% 2
  • Corticosteroid injection, with a cure rate of 61% 2
  • Expression of cyst content, with a cure rate of 39% 2
• Intralesional steroid therapy is also an option, with a complete response rate of 53.3% at the first follow-up visit and a cure rate of 40% after 1 year of follow-up 3

Postoperative Outcome

• A study on dogs with inflammatory interdigital nodules found that surgical treatment with carbon dioxide laser had a mean healing time of 34 days, with resolution seen in 42 of 47 paws 4
• The study also found that the postoperative outcome using a wound-healing protocol avoiding use of antimicrobials can be used without compromising patient care 4

Complications and Recurrence

• Interdigital cysts can be associated with severe complications, such as bacterial infections, abscesses, and osteomyelitis 5
• Recurrence rates vary depending on the treatment option, with a recrudescence rate of 27.3% after 1 year of follow-up for intralesional steroid therapy 3