Can I use Drysol (aluminum chloride) for the treatment of symptomatic athlete's foot with bacterial overgrowth?

Drysol for Athlete's Foot with Bacterial Overgrowth

No, do not use Drysol (aluminum chloride) as primary treatment for symptomatic athlete's foot with bacterial overgrowth—instead, use topical terbinafine 1% cream twice daily for 1 week to address the underlying dermatophyte infection, combined with measures to reduce moisture and bacterial proliferation. 1

Understanding the Clinical Context

Symptomatic athlete's foot with bacterial overgrowth represents a complex infection where dermatophytes invade the horny layer first, followed by bacterial overgrowth stimulated by accumulated moisture. 2 The wet, macerated presentation is particularly associated with Gram-negative organisms like Pseudomonas aeruginosa in polymicrobial combinations. 1

Evidence-Based Treatment Algorithm

Primary Antifungal Therapy

• Apply topical terbinafine 1% cream twice daily for 1 week as recommended by the American College of Physicians for patients with bacterial overgrowth and wet, macerated athlete's foot. 1
• Terbinafine demonstrates 89% combined mycologic and clinical cure rates at 2-week follow-up in chronic tinea pedis. 3
• If topical therapy fails, the Infectious Diseases Society of America suggests oral terbinafine 250 mg daily for 1-2 weeks for severe or resistant cases. 1

Addressing Bacterial Overgrowth

• Expose feet to air by wearing sandals to enhance evaporation and prevent moisture accumulation that stimulates bacterial proliferation. 2
• While aluminum chloride (Drysol) has been historically described as combining broad-spectrum antimicrobial activity with chemical drying, 2 current evidence-based guidelines prioritize antifungal agents with antibacterial properties over aluminum chloride alone.
• The best clinical results are achieved with azole compounds having mixed antibacterial and antifungal properties, rather than pure antibacterial agents. 4

Critical Adjunctive Measures

• Apply foot powder after bathing to reduce recurrence from 8.5% to 2.1%, as recommended by the American Academy of Dermatology. 1
• Change socks daily and use absorbent cotton socks rather than synthetic materials. 5
• Wear nonocclusive leather shoes or sandals to promote air circulation. 5

Special Considerations and Pitfalls

Don't Overlook Gram-Negative Organisms

The Centers for Disease Control and Prevention advises against overlooking Gram-negative organisms in severe macerated cases, which may require broader antimicrobial coverage beyond what aluminum chloride alone provides. 1

Address the Fungal Reservoir

• Treat concomitant onychomycosis, as nail infection serves as a reservoir for reinfection, according to the American Podiatric Medical Association. 1
• Gram-negative bacteria are not found in normal toe spaces but appear with increasing frequency as symptoms progress from mild to severe. 4

High-Risk Populations

The American Diabetes Association recommends particular attention to diabetic patients with macerated interdigital spaces, as fissures serve as portals for streptococcal cellulitis. 1

Why Not Drysol as Primary Treatment?

While aluminum chloride was historically considered for its drying and antimicrobial properties, 2 modern evidence demonstrates that:

• Antifungal therapy must address the underlying dermatophyte infection that initiates the disease process. 2
• Pure antibacterial agents like framycetin provide symptomatic relief but inferior results compared to agents with combined antifungal and antibacterial properties. 4
• The isolation rates of dermatophytes increase as bacterial numbers decrease with pure antibacterial treatment, suggesting fungal persistence. 4