OTCs Today

Dan Krinsky, MS, RPh

Fungal skin infections can be difficult to treat, leading to chronic lesions and a decrease in quality of life. Three of these that can be treated with self-care include tinea pedis (also called athlete’s foot), tinea corporis (ringworm), and tinea cruris (jock itch). Any individuals with fungal infections involving the nails/nailbeds (tinea unguium) or the scalp/eyebrows/eyelashes (tinea capitis) should be referred to a primary care provider (PCP) for treatment. The goals of self-treatment are 1) to provide symptomatic relief of itching, burning, and other discomfort; 2) to inhibit the growth of fungi and cure the disorder; and 3) to prevent recurrent infections. You can play an important role in helping your patients effectively manage these conditions.

Nondrug treatment options are important in the overall management of these infections. Recommend that your patients cleanse their skin daily with soap and water, and thoroughly pat dry to remove oils and other substances that promote growth of fungi. They should prevent the spread of infection by using a separate towel to dry the affected area or drying the affected area last.
Recommend use of protective footwear in areas of family or public use, such as home bathrooms or community showers.

Select nonprescription topical agents to treat each type of infection are summarized in the table. Available dosage forms include ointments, creams, powders, and aerosols. Creams or solutions are the most efficient and effective dosage forms for delivery of the active ingredient to the epidermis.

Sprays and powders are less effective because they often are not rubbed into the skin and are probably more useful as adjuncts to a cream or a solution, or as prophylactic agents in preventing new or recurrent infections. Patient adherence is influenced by product selection. Recommend a drug and dosage form that are likely to cause the least interference with daily habits and activities without sacrificing efficacy.

Whatever therapy is chosen, adherence is critical. As with any type of infection, symptom resolution does not mean that the patient can stop therapy. Butenafine hydrochloride and terbinafine hydrochloride may appear superior for athlete’s foot because some patients may achieve a cure after one week. However, the evidence suggests that the number of patients achieving complete resolution is low and that the effectiveness of these agents parallels that of other antifungals approved for nonprescription use.

Patients with diabetes should have their blood glucose levels under control because increased glucose in perspiration may promote fungal growth. Patients with allergic dermatitis often have a history of asthma, hay fever, or atopic dermatitis; therefore, they may be extremely sensitive to many oral and topical agents.

Women who are pregnant should be seen and treated by their PCP or obstetrician. Product line extensions that carry the same brand name do not necessarily have the same active ingredient(s); for example, the Lotrimin family of products contains either clotrimazole 1%, miconazole 2%, or butenafine 1%.

Some exclusions for the use of self-care for fungal infections include the causative factor being unclear; signs of a possible secondary bacterial infection; the condition being extensive, seriously inflamed, and/or debilitating; and the patient having a fever.

Key points to emphasize with your patients include:

• Proper application technique
• Required duration of therapy
• Proper care of the infected skin site
• Appropriate laundry techniques
• Avoidance of habits or behavior that may lead to recurring infections
• When to consult with their PCP

Many common fungal infections can be treated with self-care measures, including the use of a topical antifungal agent. Help your patients select the most appropriate product to cure the infection. ■