From the Guidelines
Vesiculobullous tinea pedis requires a more aggressive treatment approach, prioritizing both topical and oral antifungal medications to manage its inflammatory nature and prevent secondary bacterial infections. The management of vesiculobullous tinea pedis involves:
- Topical antifungals such as ciclopirox 0.77% cream applied twice daily for 4 weeks, which has been shown to be effective in eradicating T pedis and superior to 1% clotrimazole cream or ciclopirox vehicle in achieving both clinical and mycological cure 1.
- Oral antifungal therapy for more severe or extensive cases, with options including terbinafine, itraconazole, or fluconazole.
- Additional measures such as wet compresses with aluminum acetate (Burow's solution) to dry vesicles and provide symptomatic relief.
- Prevention of recurrence through desk hygiene, wearing breathable footwear, changing socks daily, and avoiding walking barefoot in public areas. It is essential to note that obesity and diabetes are additional risk factors for T pedis 1, and patients should be advised on measures to prevent recurrence, including the use of antifungal powders and proper foot care 1. The goal of treatment is to eradicate the fungal infection, prevent secondary bacterial infections, and improve the patient's quality of life.
From the Research
Management of Vesiculobullous Tinea Pedis
The management of vesiculobullous tinea pedis, a blister-like form of athlete's foot, involves various treatment options.
- Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, including the vesiculobullous form 2.
- Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 2.
- Oral antifungal therapy may be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients 2, 3.
- Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole, and fluconazole 2, 3.
- Combined therapy with topical and oral antifungals may increase the cure rate 2.
Treatment Duration and Frequency
- Topical antifungal therapy can be applied once to twice daily for 1-6 weeks 2.
- Terbinafine 1% cream applied twice daily for 1 week has been shown to be effective in treating tinea pedis, with a mycological cure rate of 93.5% 4.
- A single application of 1% terbinafine cream has also been shown to achieve a cure rate of 78% in patients with tinea pedis 5.
Specific Considerations for Vesiculobullous Tinea Pedis
- The vesiculobullous form of tinea pedis is an inflammatory form of the disease, and treatment may need to be adjusted accordingly 6.
- Agents with known anti-inflammatory action may be necessary to reduce inflammation 6.
- Systemic antifungal therapy may be required for severe or chronic presentations of tinea pedis, including the vesiculobullous form 6, 3.