Tinea Pedis in Diabetic Patients

People with diabetes are at a higher risk of tinea pedis, a contagious fungal infection of the feet. Compared to healthier individuals, diabetic patients are more likely to experience further complications like secondary bacterial infections, cellulitis, paronychias, foot ulcers, osteomyelitis, as well as gangrene and lower limb amputation. Due to these possible complications, it is imperative that diabetic patients receive safe and effective treatment of tinea pedis.

For healthy individuals, it is unlikely that any of these adverse complications will develop, so at worst, tinea pedis in their case is uncomfortable and visually displeasing.

Tinea pedis usually manifests as red and itchy scales in between the toes. It may also be present on the soles of the feet. There are instances when tinea pedis may also present itself alongside onychomycosis which will cause thickening and yellowing of toenails that may eventually become brittle, too. As mentioned above, this is contagious, so when left untreated there is a possibility of the infection spreading to all the toenails and both feet.

Ulceration may occur when one has tinea pedis and there is a development of skin fissures in the plantar or inter-digital skin. This creates an entryway for pathogens that will eventually promote further complications.

Why are diabetic patients at an increased risk of complications? It is because they often suffer elevated blood sugar levels, peripheral neuropathy, retinopathy, and impaired immune function which prevents recognition, response, and recovery from any injury.

CONSIDERED KEY TREATMENTS

Some evidences suggest that the most efficient topical antifungal treatment for tinea pedis is terbinafine. While these are highly applicable for otherwise healthy patients, the results of these studies are not especially relevant for diabetic sufferers. Unfortunately, they  maybe resistant to most antifungal treatment regimens due to their high blood sugar levels, as well as other factors. The inability to maintain clean and dry feet also fosters fungal growth, making improvement more difficult.

Itraconazole is avoided when one has diabetes, especially if oral hypoglycemic medication is taken. As it belongs to the imidazole family, it metabolizes by the cytochromeP450 3A4 enzyme pathway. Many medications metabolize by this pathway so itraconazole has the potential for drug interactions. If patients taking oral hypoglycemic nedications take itraconazole, their plasma levels can also rise and result  in hypoglycemia.

Due to dangerous potential drug interactions and side effects of oral medication, topical treatments are mostly preferred for diabetic patients.

Whether one has diabetes or not, tinea pedis should not be ignored and should be given proper treatment at its onset. If you notice its symptoms, visit your podiatrist to see the best course of action for you.