Topical treatments for fungal infections of the skin and nails of the foot.

There is wide variation in the methods of treating fungal infections
of the skin and toe nails of the foot which reflects the uncertainty
surrounding efficacy. Uncertainty also extends to the optimal period
of treatment, appropriate dosage of drug and frequency of
application. Topical preparations are much less costly than orally
administered antifungal drugs and cause minimal adverse side effects.
However, whilst they may be helpful in treating the symptoms
in localised skin infections, uncertainty exists as to their effectiveness
in the complete eradication of the infecting organisms.
The ideal topical antifungal for the treatment of fungal infection
should be fungicidal so that treatment can be of short duration, it
should obtain high cure rates, minimise relapses, be conducive to
participant compliance and have minimal adverse effects.
Why it is important to do this review
Fungal infections of the feet are treated by dermatologists, general
practitioners and podiatrists. A systematic review of the various
therapies used in the topical treatment of fungal infections affecting
the skin and nails of the foot will help to inform the treatment
approach of all these professionals.
O B J E C T I V E S
To identify and evaluate the evidence for topical treatments for
fungal infections of the skin and nails of the foot.
To establish the effectiveness of topical treatments used for fungal
infections of the skin and nails compared with other treatments
or untreated controls.
M E T H O D S
Criteria for considering studies for this review
Types of studies
All randomised controlled studies of topical treatment for fungal
infections of the skin and nails of the foot.
Types of participants
All men and women of any age who have a fungal infection of
the skin or nails of human foot which has been identified by microscopy
and growth of dermatophytes in culture.
Types of interventions
Any programme of treatments administered topically to treat fungal
infections of the feet compared with other treatments, placebo
or no treatments. All types of intervention were considered.
Types of outcome measures
Primary outcomes
1. For each trial we calculated the treatment failure rate at follow up
from the reported mycological results (defined as negative results
on microscopy and no growth of dermatophyte in culture). In
the update of the review we have only included studies which
subject all skin and nail samples to KOH (potassium hydroxide)
and culture).
2. Quality of life as measured by the cosmetic acceptability of the
end result to the participant, absence of itchiness, independence
from medical treatment and advice with respect to the condition.
Secondary outcomes
1. Measurement of recurrence of the condition in:
(a) skin - maintenance of cure 12 weeks after initiation of intervention;
(b) nail - maintenance of cure 36 weeks after initiation of intervention.
2. Side effects as measured by the frequency of reported adverse
events.
Search methods for identification of studies
Electronic searches
We searched the Cochrane Skin Group Specialised Register (January
2005) search strategy in Appendix 1:
We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library Issue 1, 2005) using the search
strategy in Appendix 2
We searched MEDLINE (OVID) (from inception to January
2005) using the strategy in Appendix 3.
We searched EMBASE (from inception to January 2005) using the
following keywords: athlete’s foot, tinea pedis, topical treatment
and onychomycosis.
Other databases
Topical treatments for fungal infections of the skin and nails of the foot. (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
We searched the following databases in March 2005 using the term
’athlete’s foot’ in each:
Science Citation Index and Social Science Citation Index within
BIDS
3