Marc A. Brenner, DPM

Tinea pedis and onychomycosis are among the most common diseases podiatric physicians encounter. The foot in general, for many patients as well as their general practitioner, is probably the most neglected part of their anatomy. We all tend to abuse these wonderfully complicated organs by jamming and cramming them all too often into the dark, damp confines of improper footgear. We continuously traumatize and torture them throughout our daily travels. Located at the most distal end of our structure, furthest away from blood flow, we frequently tend to ignore, hide, and even deny their existence. After a while, it is not uncommon for this masterpiece of engineering, (as Leonardo DaVinci described our feet), to cry out in pain and thus demand our immediate attention.

The fungi which affects humans are relatively few, though their effect is often pruritic, painful, and at times, dramatic (see figure 1 below). The most guilty go by the names of trichophyton rubrum, trichophyton mentagrophytes and epidermophyton floccosum. These dermatophytes are dispersed in our environment, and as such have been isolated in mainly footgear. Locker rooms, shower stalls, swimming pool areas, and pedicure footbaths are also frequently homes for these organisms. The diagnosis of tinea pedis is usually based on clinical findings that include: peeling, macerations, fissures, scaling, puritus and erythema. Cultures are frequently used by astute physicians.

The challenge of correct diagnosis of tinea can at times be difficult since it frequently mimics other pedal dermatological entities like: xerosis, atopic or contact dermatitis, erythrasma and others. Onychomycosis, of course, is a direct cousin and one does not get this without having tinea. Treatments for both are usually topical first, using Polyenes or Azoles. Gordochom Solution, Clotrimazole, Econazole, Nystatin, etc. are all effective. Orals may be added in severe resistant cases. Finally and most importantly, attacking the fungus where it lives is mandatory. It is here that Mycomist creates the best results. The active ingredients are Chlorophyll, Formalin, and Benzalkonium Chloride. Spray into shoes and boots and enclose the footgear in a plastic bag. Seal for 24 – 48 hours. Remove shoes/boots from bag and allow to air dry. Mycomist's uniqueness is that it is specifically and only designed for footgear, not for human skin.

CASE STUDY

A diabetic, hypertensive, slightly obese 54 year old Spanish female came for help with an acute dermatophyte infection of 3 months on the plantar arch of the left foot. Both hallux nails were onychomycotic. Pedal pulses were intact. She is a non-smoker but states that alcohol ingestion is a daily event. Cultures were taken, blood sugars and A1C were suggested and diabetologist contacted.

Plan: Started topical Gordochom Solution, one week of Lamasil, 250 mg orally, and twice daily usage of Mycomist in all footgear. Instructions were given carefully.

Figure 1: Before Treatment		Figure 2: Two Weeks After Treatment

###

Gordon Laboratories, located in suburban Philadelphia, is a leading manufacturer of topical pharmaceuticals today, continuing its tradition of innovation and service to Physicians, drug wholesalers, hospitals and pharmacies. The highest quality products and services remain our top priority. To learn more about Gordon Laboratories and its products and services, visit www.gordonlabs.net or call 800-356-7870.