There is a Fungus Among Us – Lets Kill It!

Topical fungal infections on various parts of the body are are considered to be a major health problem worldwide. These infections are often named after the body part they infect such as body ringworm (tinea corporis), athlete’s foot (tinea pedis) and jock itch (tinea cruris). Usually these infections do not pose serious problems but they are uncomfortable causing significant pain and itching. Effective treatment can be accomplished with over the counter medications but it is important to understand the available products.

There are two types of medications on the market. One type will inhibit the growth of the fungus (fungistatic) while the other will actually kill it (fungicidal). A fungistatic drug will prevent the fungus from reproducing and a fungicidal drug actually kills the fungus decreasing the number of fungal cells.

The medications available over the counter which are fungistatic are:

• clotrimazole (Cruex® cream, Lotrimin AF®)
• miconazole (Cruex® spray, Desenex® powder, Lotrimin AF® powder)
• *tolnaftate (Lamisil AF Defense® powder, Tinactin® cream and spray)

*it is not clear if tolnaftate is fungicidal or fungistatic

The above medications require twice daily treatment for 4 weeks to be effective.

The over the counter medications considered to be fungicidal are:

• butenafine (Lotrimin Ultra® cream)
• terbinafine (Lamisil AT® cream, spray pump, solution, gel)

The fungicidal medications generally require less frequent applications or for a shorter duration of time or both. The frequency and duration of treatment varies depending on the product and the location of the fungal infection. The shortest schedule is once daily for 7 days for Lamisil AT® gel when used for athlete’s foot between the toes.

As a general rule the fungistatic medications cost less to purchase than the fungicidal products, but in the long run you end up having to purchase multiple packages to complete the 4 weeks of therapy. As a result it may be cost effective to spend a little more up front to treat the problem with a single tube of medication.

You will notice there are multiple packages on the shelf with the same name but different claims. One package will say for jock itch while another will say athlete’s foot. This is due to the FDA labeling requirements and package information for each condition. For example, Lamisil AT® cream is available for both jock itch and athlete’s foot. The package for jock itch is labeled to be used once daily for 1 week but the one for athlete’s foot is labeled as twice daily for 1 week (between the toes) and twice daily for 2 weeks on the bottom or sides of the foot. Follow the instructions for the specific product and area you are treating.

Tips For Effective Treatment

• Wash the affected area carefully and pat dry with a towel.
• Do not use the above towel to dry other parts of the body and be sure to wash this towel after each use.
• Chose a product that is fungicidal whenever possible and follow all instructions on the package.
• Chose the product with shortest duration of therapy for the area you are treating (applying a product twice a day for 4 weeks can be difficult to complete).
• Wait 15 minutes after washing and drying before putting clothing over the affected area.
• Keep the affected area as dry as possible.
• Do not wear the same article of clothing over the area for 2 consecutive days.
• Wash all clothing and towels that contacts the affected area with hot water and dry them in the hot cycle of the dryer.
• Wear breathable cotton clothing over the affected areas.
• For athlete’s foot, wear non-occlusive shoes such as sandals whenever possible and do not wear the same pair of shoes 2 days in a row. You can also treat the shoes with one of the powdered antifungals available.
• When all symptoms have resolved, keep treating for 3 to 7 days to ensure the condition does not return.

Follow the above tips and you will have the best chance of a successful treatment.

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