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Question answered:24/07/06 Warning! this question is over two years old.
We have found no information from our sources as to the best treatment for persistent fungal skin infection. However, Clinical Evidence contains a chapter on athlete’s foot (1) which discusses the effects of tropical treatments for athlete’s foot. The key messages of which have been reproduced below.
“Topical allylamines (naftifine, terbinafine) One systematic review and four subsequent RCTs found that allylamines were more effective than placebo for curing fungal skin infections. One small RCT identified by the review found no significant difference in cure rates between the naftifine and terbinafine. The review also found that topical allylamines increased cure rates at 3–12 weeks compared with topical azoles. However, three subsequent RCTs found no significant difference in cure rates between topical azoles and allylamines.
Topical azoles One systematic review found that azole creams given for 4–6 weeks increased cure rates compared with placebo. One systematic review found insufficient evidence of a difference between individual azoles given for 3–7 weeks. The review also found that topical azoles were less effective than topical allylamines in increasing cure rates at 3–12 weeks. However, three subsequent RCTs found no significant difference in cure rates between topical azoles and allylamines.
Improved foot hygiene, including socks, and hosiery We found no systematic review or RCTs on the effects of foot hygiene and hosiery in the treatment of athlete’s foot.”
Prodigy contains a guideline on fungal (dermatophyte) skin infections (2), which offers treatment options for athlete’s foot, tinea cruris and tinea corporis, mostly caused by Trichophyton rubrum. Again the treatments discussed are not specific to persistent infection, however, the guideline offers alternative options if first-line treatment is unsuccessful. The information is to extensive to be reproduced here, but can be viewed in full by following the link in the references.
- http://www.clinicalevidence.com/ceweb/conditionpdf/1712.pdf
- http://www.prodigy.nhs.uk/fungal_skin_infections/view_whole_guidance
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