From the FDA Drug Label
Directions clean the affected area and dry thoroughly apply a thin layer of the product over affected area twice daily (morning and night) or as directed by a doctor for athlete's foot & ringworm, use daily for 4 weeks; for jock itch, use daily for 2 weeks Active ingredient Miconazole nitrate 2%
The best course of treatment for the patient is to apply Miconazole 2% to the affected areas twice daily for 4 weeks, as the rash is suspected to be a fungal infection, possibly ringworm. It is essential to clean and dry the affected areas thoroughly before application. The patient should also be advised to practice good hygiene, such as wearing well-fitting, ventilated shoes and changing socks at least once daily, to help manage excessive sweating and prevent the spread of the infection 1.
From the Research
The best treatment for this 38-year-old male with a demarcated erythematous rash likely involves both topical and systemic antifungal medications, with terbinafine being the preferred option due to its fungicidal activity and high efficacy rates 2. I recommend starting with topical terbinafine 1% cream applied twice daily to the affected areas on the left limb and right foot for 2-4 weeks. For more extensive fungal infections, oral terbinafine 250mg daily for 2-6 weeks may be necessary. Some key points to consider when treating fungal infections include:
- The importance of addressing the underlying cause of the infection, in this case, excessive sweating (hyperhidrosis) which can exacerbate fungal infections by creating a moist environment favorable for fungal growth 3.
- The use of antiperspirants containing aluminum chloride, such as Drysol 20%, applied to dry skin at bedtime and washed off in the morning, can help reduce sweating.
- Practical measures such as keeping the affected areas dry, wearing moisture-wicking socks, changing socks frequently, using antifungal powder in shoes, and allowing shoes to dry completely between wears can help prevent recurrence.
- The choice of antifungal medication should be based on the type of fungal infection, with terbinafine being a good option for dermatophyte infections 2, and azole antifungals being more effective for yeast infections such as those caused by Candida albicans 4.
- The quality of evidence supporting the use of terbinafine is high, with studies showing its efficacy and safety in the treatment of fungal infections 2, 5. It is also important to note that the patient's symptoms and response to treatment should be closely monitored, and adjustments made as necessary to ensure the best possible outcome.