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Issue 2 (2004)

GD News
GD develops concept for interdisciplinary management of Tinea pedis

Mycoses pedis soon under control?

Mycoses pedis belong to the most frequent human infectious diseases. According to latest insights, approximately one third of all adults suffer from a fungal disease of the foot (Tinea pedis). Although in the last years comprehensive efforts have been undertaken to combat mycoses pedis, their prevalence in the population has even further increased. The GD Gesellschaft für Dermopharmazie (Society for Dermopharmacy) intends to stop this drawback. For this aim they have prepared a concept for an interdisciplinary management of Tinea pedis providing a close cooperation of physicians and pharmacists and considering the fact that highly effective topical antimycotics are predominantly applied in the scope of self-medication today.

„Tinea pedis is a superficial skin disease of the foot which is caused in roughly 98 percent of all cases by dermatophytes (filamentous fungi) and here in particular the Trichophyton rubrum“, explains private lecturer Dr. med. Monika Schmid-Wendtner from the Dermatological Clinic of Bonn University on the occasion of a press conference organized by the Gesellschaft für Dermopharmazie in Hamburg on 9 September 2004. In rare cases also saccharomyces, in particular Candida albicans, or mould are found at the place of infection.

Particularly common, according to Schmid-Wendtner, micro-organisms cause an infection of the toe interdigit (Tinea pedis interdigitalis). From here the infection can spread to the sole of foot, the toenails or even to other regions of the body its control becoming then much more difficult. Moreover, mycoses pedis as could be shown by a recent case-control study favour the incidence of bacterial secondary infections of the lower leg (erysipel).

Itching and burning
of the skin

Clinically visible is mainly the whitish swelling of the upper layers of the skin and possibly an inflammatory reddening. Occasionally, small vesicles are formed or the skin tears and weeps. Persons concerned often only notice the infection when itching and burning of the skin appear. There is an increased incidence of the disease with age affecting more men than women.

The generation of a humid warm climate favours the fungal growth in the toe interdigit as is often the case when wearing shoes of material which is little permeable to air. However, also defective positions of the foot entailing a stricture and encapsulation of the toe interdigits, diabetes mellitus, lowered resistance acquired as well as the habits of today’s leisure time (swimming, sauna) are considered to be favouring factors for the incidence of mycoses pedis.

Fungi-statically and fungicidally
effective antimycotics

Principally topical antimycotics are considered for treatment which are available as ready-to-use products in several cutaneous presentation forms (for example as cream, gel or solution). The most important active agents belong to the substance classes of azoles, allylamines and hydroxy pyridones. „Azoles mainly have a fungistatical effect, i.e. they inhibit the fungal growth and prevent its dispersion“, private lecturer Dr. Schmid-Wendtner comments. “Therefore, based on these active agents, a three-to-four-week treatment is required in any case because only the permanent renewal of skin eliminates the fungus completely.

The concept for interdisciplinary management of Tinea pedis has been introduced on the occasion of a press conference organized by the GD in Hamburg on 9 September 2004. Participants at the press conference were (from left): professor Dr. med. Hans Christian Korting, Munich, private lecturer Dr. med. Monika Schmid-Wendtner, Bonn, Juliane Papendorf, moderator of the press conference, Hamburg, and Dr. Joachim Kresken, Viersen.

The situation is different, however, as concerns the allylamine Terbinafin: this substance has a definite fungicidal effect, i. e. it kills the fungus. Schmid-Wendtner: „ Owing to its depot effect still over one week after the last application, Terbinafin can be proven in fungicidally effective concentrations in the stratum corneum, the duration of therapy at a Tinea pedis interdigitalis can be reduced here to one week based on an application merely once a day.

A taboo subject
in the population

Despite its enormous proliferation, Athlete’s foot is still a taboo subject in the population. „A lack of information entails that every seventh person concerned remains without treatment“, Dr. Joachim Kresken, head of a public pharmacy in Viersen and President of the Gesellschaft für Dermopharmazie emphasizes. „There is an enormous necessity for information and advice which cannot solely be performed by the physician but in which pharmacies should be included as well“. As most topical antimycotics are no longer subject to prescription and therefore since 1 January 2004 only refundable for prescription to children until the terminated 12th year of life and adolescents with development disturbance until the terminated 18th year of life by the public health funds, the self-medication of mycoses pedis – and in particular here the Tinea pedis interdigitalis – has in recent times undoubtedly increased in significance, according to Kresken.

Thus at the same time the requirement of qualified consultation in the pharmacy has become increasingly significant. Confronted with the fact that many persons affected prefer a treatment without consulting a physician first, the pharmacist has to ponder whether a self-medication is really indicated or the person concerned should be referred to consult a physician first.

The statement of the interdisciplinary management of Tinea pedis has been established by an expert group acting on behalf of the GD committee and adopted on the occasion of a consensus conference in Düsseldorf on 15 July 2004. Members of the expert group were (from left) the practising dermatologist Dr. med. Winfried Klövekorn, Gilching, the pharmacists Dr. Joachim Kresken, Viersen and Dr. Ursula Schöffling, Trier, as well as the dermatologists professor Dr. med. Hans Christian Korting, Munich and private lecturer Dr. med. Monika Schmid-Wendter, Bonn, both active in clinics.

Interdisciplinary management
raises hop

The Gesellschaft für Dermopharmazie has recently presented a statement adopted by dermatologists and pharmacists in the course of a consensus conference taking these facts in consideration. The new consensus paper which has been introduced by the vice-president of the GD, professor Dr. med. Hans Christian Korting from the Clinic and Polyclinic for Dermatology and Allergology of the Ludwig-Maximilians-University Munich generally regulates the following issues:

The particularly frequent intertriginous-macerative type of Tinea pedis is as a rule qualified for self-medication whereas the more seldom appearing hyper-keratotic and the even less frequent bullous type should not be treated without medicinal diagnosis.

At a given indication, the pharmacist should if so possible recommend a highly-effective anti-mycotic giving rise to the expectation that healing is feasible for the majority of the persons concerned at first go.

Moreover, attention is to be paid when selecting a suited product to the fact that the vehicle has to be individually adjusted to the varying skin condition.

In case the treatment is not successful or the infection has already spread far beyond the toe interdigit, the pharmacist should in any case express the advice to consult a specialized physician, normally a dermatologist, who as a clinical specialist has the competence to perform the mandatory laboratory diagnostics.

„A management of the kind, envisaging a close cooperation of pharmacist and physician provides the opportunity to gradually improve the epidemiologically utmost unsatisfactory situation for the wide-spread Tinea pedis interdigitalis“, professor Korting summarizes.

The exact wording of the GD statement „Interdisciplinary Management of Tinea pedis” as well as the press text published on the occasion of the press conference organized by the GD in Hamburg on 9 September 2004 has been published at the GD homepage (


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