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Common Fungal Infections of the Feet in Patients with Diabetes Mellitus

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Abstract

Superficial fungal infections of the foot (tinea pedis and onychomycosis) are common among elderly patients. Although most authorities believe that patients with diabetes mellitus have an increased predisposition to dermatophytic infections, some controversies still remain. Because these infections disrupt the skin integrity and provide an avenue for bacterial superinfection, elderly diabetic patients with dermatophytic infection should be promptly treated with an antifungal agent. For most dermatophytic infections of the foot, topical agents are usually effective and less expensive than oral agents. Laboratory diagnosis of fungal infection prior to institution of therapy is recommended. Proper technique for obtaining the specimen is important to ensure a higher chance of isolating the infecting fungus. Commonly used anti-dermatophytic agents that are also active against the yeasts include the imidazoles, the allylamines-benzylamines and the hydroxypyridones, which are also effective against most of the moulds. Oral therapy for tinea pedis, although not well studied, should be limited to patients with more extensive infections, such as vesicobullous and moccasin type, resistant infections or chronic infections. In addition, oral agents should also be considered in diabetic and immunosuppressed patients. On the other hand, treatment of onychomycosis of the foot usually requires systemic therapy. Griseofulvin is the least effective agent when compared with the newer agents. Terbinafine, itraconazole and fluconazole have been shown to have acceptable cure rates. More recently, topical treatment of the nail with 8% ciclopirox nail lacquer, bifonazole with urea and amorolfine have been reported to be successful. Over the past decade, fungal foot infections of the skin and nail are more effectively treated with the introduction of numerous topical and oral agents.

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Infectious Disease Section, Northeastern Ohio Universities College of Medicine, Ohio, USA

    James S. Tan

  2. Department of Internal Medicine, Summa Health System, 75 Arch Street, Suite 105, Akron, Ohio, 44304, USA

    James S. Tan

  3. Section of Infectious Diseases, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

    Warren S. Joseph

  4. Veterans Affairs Medical Center, Coatesville, Pennsylvania, USA

    Warren S. Joseph

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Correspondence to James S. Tan.

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Tan, J.S., Joseph, W.S. Common Fungal Infections of the Feet in Patients with Diabetes Mellitus. Drugs Aging 21, 101–112 (2004). https://doi.org/10.2165/00002512-200421020-00003

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