Drysol (Aluminum Chloride) for Athlete's Foot with Bacterial Overgrowth
Drysol (aluminum chloride) is an effective adjunctive treatment for athlete's foot with bacterial overgrowth when combined with topical terbinafine, as it provides both broad-spectrum antimicrobial activity and chemical drying to suppress the bacterial component that drives symptomatic flare-ups. 1
Rationale for Combination Therapy
The pathophysiology of symptomatic athlete's foot involves a two-stage process: fungal invasion of the horny layer followed by bacterial overgrowth stimulated by moisture accumulation, which causes the wet, macerated presentation. 1
Dermatophytes (primarily T. rubrum and T. mentagrophytes) initiate the infection, but large numbers of aerobic diphtheroids and Gram-negative organisms (Pseudomonas, Proteus) are responsible for the symptomatic wet, macerated type of athlete's foot (dermatophytosis complex). 1
Suppression of bacteria is essential in treating symptomatic athlete's foot, and aluminum chloride provides a two-pronged attack: broad-spectrum antimicrobial activity combined with chemical drying. 1
Treatment Algorithm
Primary Antifungal Coverage
Apply topical terbinafine 1% cream twice daily as the primary antifungal agent, which has superior fungicidal activity against dermatophytes and can achieve 78-89% combined mycologic and clinical cure rates. 2
Terbinafine offers the advantage of shorter treatment duration (typically 1 week) compared to other topical agents, though 4 weeks may be needed for chronic cases. 3, 4
Adjunctive Bacterial Suppression
Apply aluminum chloride (Drysol) to affected areas to address the bacterial overgrowth component, particularly in wet, macerated interdigital spaces. 1
The drying effect is the decisive element in controlling bacterial proliferation that drives symptomatic flare-ups. 1
Alternative Topical Antifungal Options
If terbinafine is not tolerated or available:
Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks provides broad-spectrum coverage and achieves approximately 60% cure at end of treatment and 85% two weeks post-treatment. 3, 5
Clotrimazole 1% cream twice daily for 4 weeks is less effective but remains a viable alternative. 3, 5
Preventive Measures to Implement Concurrently
Thorough drying between toes after showers is critical to prevent moisture accumulation that stimulates bacterial overgrowth. 3, 5
Daily sock changes and periodic cleaning of athletic footwear reduce reinfection risk. 3, 5
Foot powder application after bathing has been associated with decline in tinea pedis rates from 8.5% to 2.1%, primarily by reducing T. mentagrophytes. 3
Wearing nonocclusive leather shoes or sandals enhances evaporation and prevents moisture accumulation. 6
Important Caveats
Permanent eradication is unlikely because dermatophyte reservoirs in nails and soles ensure reinfection, making this primarily a seasonal disease in temperate climates requiring periodic treatment of exacerbations. 1
Screen for underlying risk factors including obesity and diabetes, which increase susceptibility to tinea pedis and may affect treatment response. 3, 5
The dry, scaly type (dermatophytosis simplex) often alternates with the wet, macerated type (dermatophytosis complex), with flare-ups common in summer or with foot occlusion. 1
Exposure to air (wearing sandals) enhances water evaporation and prevents bacterial overgrowth more effectively than any topical treatment alone. 1