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Athletes feet medicine. Athlete’s Foot: Effective Treatments, Natural Remedies, and Prevention Strategies

What are the most effective treatments for athlete’s foot. How can you prevent athlete’s foot naturally. Which over-the-counter medications work best for treating fungal foot infections. What home remedies can help alleviate athlete’s foot symptoms. How long does it take to cure athlete’s foot with proper treatment. When should you see a doctor for athlete’s foot.

Understanding Athlete’s Foot: Causes and Symptoms

Athlete’s foot, medically known as tinea pedis, is a common fungal infection that affects the skin on the feet. It thrives in warm, moist environments and is often contracted in public spaces like locker rooms, swimming pools, and shared showers. The fungus responsible for athlete’s foot belongs to a group called dermatophytes, which feed on keratin – a protein found in skin, hair, and nails.

The primary symptoms of athlete’s foot include:

  • Itching, stinging, and burning sensations between the toes or on the soles of the feet
  • Cracking and peeling skin, especially between the toes and on the soles
  • Redness and scaling on the feet
  • Blisters that may ooze fluid
  • Dry, scaly skin that may extend up the side of the foot

Can athlete’s foot spread to other parts of the body? Yes, the fungal infection can spread to the toenails, hands, and groin area if left untreated. This is why prompt and proper treatment is crucial.

Over-the-Counter Treatments for Athlete’s Foot

Most cases of athlete’s foot can be effectively treated with over-the-counter (OTC) antifungal products. These come in various forms, including powders, creams, gels, lotions, and sprays. The active ingredients in these products work by killing the fungus or preventing its growth.

Common OTC Antifungal Medications

  • Terbinafine (Lamisil)
  • Clotrimazole (Lotrimin)
  • Miconazole (Micatin)
  • Tolnaftate (Tinactin)
  • Butenafine (Lotrimin Ultra)

How long should you use OTC treatments for athlete’s foot? Generally, these products should be applied daily after washing and drying the feet. Treatment should continue for 1-2 weeks after the infection appears to have cleared to prevent recurrence.

Is one type of antifungal product more effective than others? The effectiveness can vary from person to person. You may need to try a few different products before finding the one that works best for you. Always follow the instructions on the label carefully.

Prescription Treatments for Severe or Persistent Cases

In some cases, over-the-counter treatments may not be sufficient to clear the infection. If symptoms persist after two weeks of OTC treatment, it’s advisable to consult a healthcare professional. They may prescribe stronger antifungal medications.

Prescription Antifungal Options

  • Oral antifungal medications (e.g., fluconazole, itraconazole)
  • Prescription-strength topical antifungals (e.g., ciclopirox, naftifine)
  • Combination therapies involving both oral and topical medications

Why might a doctor prescribe oral antifungals? Oral medications may be necessary for severe infections, cases involving the toenails, or when topical treatments have failed. These medications work systemically to combat the fungal infection from within the body.

Natural Remedies and Home Treatments for Athlete’s Foot

While scientific evidence is limited for many natural remedies, some people find relief from athlete’s foot symptoms using alternative treatments. It’s important to note that these should not replace conventional treatments without consulting a healthcare provider.

Tea Tree Oil

Tea tree oil, derived from the leaves of Melaleuca alternifolia, has demonstrated antifungal properties. How do you use tea tree oil for athlete’s foot? Dilute the oil and apply it to the affected area twice daily. Some studies suggest it may reduce itching, scaling, and burning, but results can take up to a month to become noticeable.

Bitter Orange

Bitter orange oil has shown promise as a natural antifungal agent. In one study, a diluted form applied three times daily cleared the fungal infection within one to two weeks. However, caution is advised as bitter orange can cause skin irritation and increase sun sensitivity.

Garlic-Derived Ajoene

Ajoene, a compound found in garlic, has demonstrated antifungal properties. Available in gel form or as an oral supplement, some research indicates it may effectively treat athlete’s foot symptoms when applied once daily.

Green Tea Foot Soaks

The polyphenols in green tea possess antifungal properties. Soaking feet in lukewarm green tea may help reduce peeling and redness. However, this method requires consistency, potentially needing daily soaks for up to three months.

Hygiene Practices for Managing and Preventing Athlete’s Foot

Proper foot hygiene plays a crucial role in both treating and preventing athlete’s foot. Implementing these practices can significantly reduce the risk of infection and reinfection:

  1. Wash and thoroughly dry feet daily, paying special attention to the areas between the toes
  2. Wear breathable footwear made of porous materials
  3. Change socks or stockings daily, opting for moisture-wicking synthetic materials over cotton
  4. Alternate shoes daily to allow them to dry completely between wears
  5. Use antifungal powder in shoes and on feet to keep them dry
  6. Avoid walking barefoot in public areas like locker rooms, pools, and showers
  7. Wash socks and towels in hot water to kill fungal spores

How often should you replace your shoes to prevent athlete’s foot? While there’s no set rule, consider replacing shoes that have been frequently worn or exposed to moisture every 6-12 months, or sooner if they show signs of wear or retain odors.

When to Seek Medical Attention for Athlete’s Foot

While many cases of athlete’s foot can be successfully treated at home, there are instances when professional medical care is necessary. Consult a healthcare provider if:

  • Symptoms persist or worsen after two weeks of home treatment
  • The infection spreads to other parts of the body
  • You have diabetes or a weakened immune system
  • The affected area becomes swollen, warm, or shows signs of bacterial infection
  • You experience severe pain, fever, or other systemic symptoms

What should you expect during a doctor’s visit for athlete’s foot? A healthcare provider will likely examine your feet and may take a skin scraping for laboratory analysis to confirm the diagnosis and identify the specific fungus causing the infection.

Prevention Strategies for Athlete’s Foot

Preventing athlete’s foot is often easier than treating an established infection. Implement these strategies to reduce your risk:

  • Keep feet clean and dry, especially between the toes
  • Wear sandals or water shoes in public showers, locker rooms, and pool areas
  • Don’t share towels, socks, or shoes with others
  • Choose breathable footwear and moisture-wicking socks
  • Use antifungal powder or spray in shoes regularly
  • Trim toenails regularly to prevent fungal buildup
  • Avoid tight-fitting shoes that trap moisture

Can diet play a role in preventing athlete’s foot? While there’s no direct link between diet and athlete’s foot, maintaining a balanced diet that supports overall immune function may help your body resist fungal infections more effectively.

Complications and Related Conditions of Athlete’s Foot

If left untreated, athlete’s foot can lead to more serious complications and related conditions:

Bacterial Infections

The cracks and blisters caused by athlete’s foot can provide an entry point for bacteria, potentially leading to cellulitis or other bacterial skin infections.

Fungal Nail Infections

The fungus causing athlete’s foot can spread to the toenails, resulting in onychomycosis – a persistent and difficult-to-treat nail infection.

Chronic Athlete’s Foot

Without proper treatment, athlete’s foot can become a chronic condition, leading to persistent discomfort and increased risk of spreading the infection to others.

Jock Itch

The fungus can spread to the groin area, causing tinea cruris, commonly known as jock itch.

How can you prevent the spread of athlete’s foot to other parts of the body? Always wash your hands after touching the affected area, use separate towels for your feet, and put on socks before underwear to avoid transferring the fungus to the groin area.

Athlete’s foot, while common and often easily treatable, should not be ignored. Prompt recognition of symptoms, appropriate treatment, and consistent preventive measures can help manage this fungal infection effectively. By implementing good foot hygiene practices and being vigilant about potential symptoms, you can significantly reduce your risk of developing athlete’s foot and prevent its recurrence. Remember, persistent or severe cases warrant professional medical attention to ensure proper treatment and prevent complications.

Athlete’s Foot Treatment, Medications, Creams, & Sprays

Written by WebMD Editorial Contributors

  • What Are the Treatments for Athlete’s Foot?
  • Athlete’s Foot Medicine
  • Hygiene for Athlete’s Foot
  • Athlete’s Foot Natural Remedies
  •  Can I Prevent Athlete’s Foot?

Most cases of athlete’s foot can be cured with over-the-counter antifungal products and basic good hygiene.  Athlete’s foot is caused by a fungal infection, so the way to get rid of it is to stop the fungus from growing.

If it’s not treated properly and promptly, athlete’s foot can be very stubborn. Even when you treat it with antifungal drugs, the infection may take several weeks to disappear and may come back after treatment.

More serious cases may need to be seen by a doctor.

There are many types of over-the-counter antifungal powders, creams, gels, lotions, and sprays. You might have to try a few before you find one that works best for you.

Follow the instructions on the label of the product you buy. Generally, you apply them every day after you wash and dry your feet.  Continue treatment for 1-2 weeks after the infection has cleared to prevent it from recurring.

If the itchy rash on your feet doesn’t clear up after a couple of weeks, see your doctor. They can recommend a prescription cream or antifungal pills.

In addition to treatment, good foot hygiene is important when you have athlete’s foot.  Wash and dry your feet (including between the toes) every morning and evening. And make sure your feet get plenty of air. If you can’t go barefoot or wear sandals, wear synthetic socks that wick away moisture. Cotton tends to trap the moisture and promote fungal growth. 

Also:

  • Wear shoes made of a porous material.
  • Change socks or stockings daily.
  • Don’t wear the same shoes day after day to allow them time to dry completely before wearing them again. 
  • Wash your socks and towels in the hottest water possible.

 

Many people have their own ways to deal with athlete’s foot at home. There’s not much scientific research on how well these remedies work, but some have shown promise.

Tea tree oil. This oil comes from the leaves of a tree that grows in Australia. Because it can kill some types of bacteria and fungus, people have used it as a home remedy for many years.

When rubbed into your skin twice a day, tea tree oil may be able to reduce the itching, scaling, swelling, and burning of athlete’s foot. But it can take up to a month to see progress. And it doesn’t work for everyone.

Tea tree oil can cause a skin rash or trigger allergies. So talk with your doctor before you try it. They can suggest a tea tree product for you to try or explain how to dilute the oil to avoid side effects.

Never take tea tree oil by mouth since it can be toxic.

Bitter orange. This fruit has been used for years in Chinese medicine and by people who live in the Amazon rainforest.

Bitter orange oil is a natural fungus fighter. Besides athlete’s foot, it may help to clear up ringworm and jock itch.

One study found that when people applied a watered-down form of bitter orange oil to their feet three times a day, the fungus cleared up after a week or two.

Bitter orange can inflame your skin if you use it in its pure form. It can also make you more likely to get a sunburn, so be sure to protect your skin from the sun if you use it.

Ajoene from garlic. Ajoene is a chemical found in garlic that may ease symptoms of athlete’s foot. You can take it by mouth as an antifungal pill. You can also find it in gel form.

In one study, people who applied ajoene to their feet once a day saw their athlete’s foot symptoms go away after a week. This method might also help keep athlete’s foot from coming back.

Sunflower oil. Made from the pressed seeds of sunflowers, this oil has long been said to fight germs. Although athlete’s foot is not a germ, a brand called Oleozon, which contains ozone (another germ-killer), has been shown to get rid of athlete’s foot when applied to the feet. It’s unclear whether other brands of sunflower oil might work as well, but it may be worth trying.

Green tea. Nutrients in green tea called polyphenols have antifungal powers. Soak your feet in lukewarm green tea and you may notice less peeling and redness. 

But this method won’t work quickly. You may have to soak your feet every day for 3 months. And more studies are needed to prove that green tea can get rid of the fungus, not just make your feet feel and look better.

Sosa. People in rural parts of Mexico use leaves of the Solanum chrysotrichum plant, also called giant devil’s fig. Studies show that a cream made from an extract of this shrubby plant works as an antifungal for athlete’s foot. It could also prevent it from coming back.

But while studies show that sosa is safe to put on your skin, it may be hard to find.

Vinegar. Some people believe that soaking your feet in a mixture of water and vinegar will get rid of athlete’s foot. While a vinegar soak won’t do your feet any harm, there’s not enough research to prove it will do much good, either.

Athlete’s foot is contagious. So don’t go barefoot in public areas such as the pool or gym where many others have walked with bare feet.  And since moisture helps the fungus grow, cut your risk by keeping your feet clean and dry.

 Other sensible steps:

  • Take your shoes off when you go home and let your feet be exposed to the air.
  • Never share shoes, socks, or towels.
  • Be doubly cautious if you take an antibiotic for another condition. The medication can kill beneficial bacteria that normally control the fungus that causes athlete’s foot.

Top Picks

Athlete’s Foot Treatment, Medications, Creams, & Sprays

Written by WebMD Editorial Contributors

  • What Are the Treatments for Athlete’s Foot?
  • Athlete’s Foot Medicine
  • Hygiene for Athlete’s Foot
  • Athlete’s Foot Natural Remedies
  •  Can I Prevent Athlete’s Foot?

Most cases of athlete’s foot can be cured with over-the-counter antifungal products and basic good hygiene.   Athlete’s foot is caused by a fungal infection, so the way to get rid of it is to stop the fungus from growing.

If it’s not treated properly and promptly, athlete’s foot can be very stubborn. Even when you treat it with antifungal drugs, the infection may take several weeks to disappear and may come back after treatment.

More serious cases may need to be seen by a doctor.

There are many types of over-the-counter antifungal powders, creams, gels, lotions, and sprays. You might have to try a few before you find one that works best for you.

Follow the instructions on the label of the product you buy. Generally, you apply them every day after you wash and dry your feet.  Continue treatment for 1-2 weeks after the infection has cleared to prevent it from recurring.

If the itchy rash on your feet doesn’t clear up after a couple of weeks, see your doctor. They can recommend a prescription cream or antifungal pills.

In addition to treatment, good foot hygiene is important when you have athlete’s foot.   Wash and dry your feet (including between the toes) every morning and evening. And make sure your feet get plenty of air. If you can’t go barefoot or wear sandals, wear synthetic socks that wick away moisture. Cotton tends to trap the moisture and promote fungal growth. 

Also:

  • Wear shoes made of a porous material.
  • Change socks or stockings daily.
  • Don’t wear the same shoes day after day to allow them time to dry completely before wearing them again. 
  • Wash your socks and towels in the hottest water possible.

 

Many people have their own ways to deal with athlete’s foot at home. There’s not much scientific research on how well these remedies work, but some have shown promise.

Tea tree oil. This oil comes from the leaves of a tree that grows in Australia. Because it can kill some types of bacteria and fungus, people have used it as a home remedy for many years.

When rubbed into your skin twice a day, tea tree oil may be able to reduce the itching, scaling, swelling, and burning of athlete’s foot. But it can take up to a month to see progress. And it doesn’t work for everyone.

Tea tree oil can cause a skin rash or trigger allergies. So talk with your doctor before you try it. They can suggest a tea tree product for you to try or explain how to dilute the oil to avoid side effects.

Never take tea tree oil by mouth since it can be toxic.

Bitter orange. This fruit has been used for years in Chinese medicine and by people who live in the Amazon rainforest.

Bitter orange oil is a natural fungus fighter. Besides athlete’s foot, it may help to clear up ringworm and jock itch.

One study found that when people applied a watered-down form of bitter orange oil to their feet three times a day, the fungus cleared up after a week or two.

Bitter orange can inflame your skin if you use it in its pure form. It can also make you more likely to get a sunburn, so be sure to protect your skin from the sun if you use it.

Ajoene from garlic.  Ajoene is a chemical found in garlic that may ease symptoms of athlete’s foot. You can take it by mouth as an antifungal pill. You can also find it in gel form.

In one study, people who applied ajoene to their feet once a day saw their athlete’s foot symptoms go away after a week. This method might also help keep athlete’s foot from coming back.

Sunflower oil. Made from the pressed seeds of sunflowers, this oil has long been said to fight germs. Although athlete’s foot is not a germ, a brand called Oleozon, which contains ozone (another germ-killer), has been shown to get rid of athlete’s foot when applied to the feet. It’s unclear whether other brands of sunflower oil might work as well, but it may be worth trying.

Green tea. Nutrients in green tea called polyphenols have antifungal powers. Soak your feet in lukewarm green tea and you may notice less peeling and redness. 

But this method won’t work quickly. You may have to soak your feet every day for 3 months. And more studies are needed to prove that green tea can get rid of the fungus, not just make your feet feel and look better.

Sosa. People in rural parts of Mexico use leaves of the Solanum chrysotrichum plant, also called giant devil’s fig. Studies show that a cream made from an extract of this shrubby plant works as an antifungal for athlete’s foot. It could also prevent it from coming back.

But while studies show that sosa is safe to put on your skin, it may be hard to find.

Vinegar. Some people believe that soaking your feet in a mixture of water and vinegar will get rid of athlete’s foot. While a vinegar soak won’t do your feet any harm, there’s not enough research to prove it will do much good, either.

Athlete’s foot is contagious. So don’t go barefoot in public areas such as the pool or gym where many others have walked with bare feet.  And since moisture helps the fungus grow, cut your risk by keeping your feet clean and dry.

 Other sensible steps:

  • Take your shoes off when you go home and let your feet be exposed to the air.
  • Never share shoes, socks, or towels.
  • Be doubly cautious if you take an antibiotic for another condition. The medication can kill beneficial bacteria that normally control the fungus that causes athlete’s foot.

Top Picks

Antifungal drugs for onychomycosis and mycosis of the feet – we are studying the category

Fungal infections are one of the most urgent and not completely solved problems of modern medicine. According to the World Health Organization, 90% of the world’s inhabitants have experienced fungal diseases at least once in their lives, and every 3rd person has mycosis. At the same time, the incidence of these diseases increases. Fungal lesions of the skin in the general structure of dermatological nosologies occupy the 2nd place. A number of medicines for the treatment of mycosis are presented on the Ukrainian pharmaceutical market. Among them there are original and generic drugs, domestic and imported, cheap and expensive. In this publication, we will analyze the category of topical drugs for foot and nail mycosis. In particular, we will consider the structure of doctors’ prescriptions and real consumption, as well as market indicators of the category. The publication uses data from the market research system “PharmXplorer” / “Pharmstandard” of the company “Proxima Research” and the syndicated database “Axioma”.

The leading role in the occurrence of mycoses of the skin and its appendages belongs to such pathogens as dermatophytes (up to 94%). Much less often, causative agents of fungal skin diseases are yeast and non-dermatophyte mold fungi. Yeast fungi – saprophytes of the skin and its appendages – are detected in 69% of healthy people. Therefore, as a rule, yeasts are secondary pathogens that do not play an important etiological role.

In Ukraine, the frequency of onychomycosis is about 50% of all fungal diseases of the skin and its appendages among the adult population. Every tenth visit to a dermatologist is associated with these diseases. In Ukraine, over the past 10 years, the incidence of foot mycosis has increased by 2.3 times. In some social groups (military personnel, athletes, miners), foot mycosis is detected with a frequency of 20–50%.

The wide spread of diseases of this group can be associated with a number of reasons. Among them, such as non-compliance with sanitary and hygienic standards, irrational use of antibacterial drugs, immunosuppressive drugs, cytostatics, glucocorticosteroids, etc. Treatment of mycosis of the feet and nails can be local, systemic and combined.

In this publication, we will consider drugs for topical use in the treatment of mycosis of the feet and nails.

How are onychomycosis and mycosis of the feet treated today?

The market of topical preparations for onychomycosis and mycosis of the feet in Ukraine is saturated: 11 international non-proprietary names (INN), 27 brands, and taking into account the forms of release – 47 commodity items (SKU). Taken together, antimycotic drugs for topical use occupy a significant share among antifungal drugs for use in dermatology (group D01 according to the ATC classification system) (Fig. 1 and 2).

Fig. 1

Average monthly sales in monetary terms of drugs of group D01 in general and for local use according to data for June 2013 – May 2014

Fig. 2

Average monthly sales in physical terms of group D01 drugs in general and for local use as of June 2013-May 2014

Today in the world (developed countries) it is customary to treat onychomycosis and mycosis of the feet with the use of drugs that belong to two classes of chemical compounds: azole derivatives (imidazoles, triazoles and thiazoles) and allylamines. The mechanism of action of most antifungal drugs is associated with the effect on enzymes that affect the biosynthesis of ergosterol, which is part of the fungal cell membrane.

Medicines containing these active substances are widely represented on the pharmaceutical market of Ukraine.

The WHO List of Essential Medicines includes 2 active ingredients miconazole and terbinafine as topical antimycotic medicines. In Ukraine, the Mandatory minimum assortment of (socially oriented) medicines and medical products for pharmacies (hereinafter referred to as the mandatory minimum assortment) includes another INN – clotrimazole.

What do doctors prescribe and what do patients buy?

The analysis of doctors’ prescriptions was carried out using the data of the “Rx test – Monitoring of drug prescriptions” project, which allows for a quantitative and qualitative analysis of the structure of prescriptions among 17 medical specialties in the context of nosological units according to the International Classification of Diseases, 10th revision (ICD-10).

In the structure of medical prescriptions (pediatricians and dermatologists) for topical drugs for fungal diseases, drugs for the treatment of mycosis of the feet and nails take 2nd and 3rd place (Fig. 3), accumulating 16% and 12% of the total number of prescriptions respectively (according to data for Q2 2013 – Q1 2014).

Fig. 3

The number of prescribing drugs for local use (group D01) by nosological groups according to data for the II quarter. 2013 – I quarter. 2014

When patients turn to doctors of such specialties as dermatology and pediatrics, and the diagnosis of foot fungus and onychomycosis is established, in the period II quarter. 2013 — Q1 In 2014, the most frequently prescribed drugs were terbinafine (41% of all prescriptions), naftifine (21%), sertaconazole (16%), bifanosol + urea (13%), ketoconazole (3%) as active ingredients. The total share in the prescriptions of other INNs (clotrimazole, isoconazole + diflucortolone, miconazole, oxiconazole, omoconazole and tridecamine undecylenate) is 9%.

Thus, the leaders in prescriptions among doctors are terbinafine, naftifine, sertaconazole and bifanozol + urea.

Ukrainians buy INN the most, which is practically not prescribed by doctors

Comparison of doctors’ prescriptions and actual consumption of drugs in this group demonstrates some “distortions”: Ukrainians mostly buy INN, which is practically not prescribed by healthcare professionals (Fig. 4). The leader in terms of sales volume in packages is INN clotrimazole, which accounts for only 2% in the structure of medical prescriptions for topical antifungal drugs for foot and nail mycosis.

Fig. 4

Share of consumption in physical terms and marginal income of INNs prescribed by doctors for foot and nail mycosis, indicating the share of prescriptions based on data for Q2 2013 – I quarter. 2014

The sale of topical preparations for use in dermatology is characterized by seasonal fluctuations. A higher level of sales is typical for the 2nd and 3rd quarters, that is, Ukrainians buy more funds from this group during the warm season (Fig. 5). This may be due to the fact that the treatment of mycosis of the feet and nails in the summer is convenient. In addition, during this period, cosmetic defects in this part of the body are more noticeable.

Fig. 5

Sales of drugs for topical use of ATC group D01 according to data for Q2 2010 – I quarter. 2014 in monetary and physical terms

It is also interesting that with an increased seasonal demand for these drugs, there is an increase in the number of memories of pharmacists about recommendations (Fig. 6). Among doctors, the dynamics of memories of appointments is less subject to seasonal fluctuations.

Fig. 6

Number of memories of doctors’ prescriptions and recommendations of pharmacists according to the data for Q2 2012 – I quarter. 2014

In other words, more pharmacists recommend topical antifungals during the warm season.

One explanation could be that when dermatological problems that aggravate during the warmer months need to be addressed, patients are referred directly to the pharmacy.

In this case, the responsibility for choosing the right therapy falls on the shoulders of the pharmacist. The pervostolnik should not only sell the drug, but provide the patient with competent advice and advice, and in case of suspicion of the presence of a disease requiring medical intervention, recommend consultation with a specialized specialist.

Group as a whole

The weighted average cost of 1 package of the category drug in May 2014 was UAH 38.09.

An analysis of the structure of INN implementation for topical use in the treatment of mycosis of the feet and nails in various types of pharmacies is presented in Table 1 (data for May 2014).

Show table in new window

Pharmacies are classified by turnover (divided into 4 categories) and outlet format (open and closed). An open form of trade assumes that the buyer has access to product packaging or there is the possibility of merchandising (the presence of racks in the hall, etc. ). The closed form implies the presence of counters or showcases, that is, the display is located only in the checkout area and the visitor does not have the opportunity to take the drug on his own. The analysis includes pharmacies that sell at least 10 packages of category drugs per month.

Let us consider in more detail the category of topical antimycotics for use in the indicated diseases in the context of INNs and brands. Topical preparations containing the indicated INNs can be dispensed in Ukraine without a doctor’s prescription.

Clotrimazole

On the Ukrainian market there are several drugs for topical use, the active substance of which is clotrimazole, both domestic and foreign.

Clotrimazole is included in the Mandatory minimum assortment according to the order of the Ministry of Health of Ukraine No. 1000. This molecule is not included in the WHO List of Essential Drugs.

Among clotrimazoles there are branded generics and generics of both domestic and foreign production. In total, 13 commodity items of medicines are currently marketed on the Ukrainian pharmaceutical market, the active ingredient of which is clotrimazole.

The structure of sales of clotrimazole commodity items in Ukrainian pharmacies of various types is presented in Table 2.

Table 2 Sales structure of clotrimazole headings in packages, indicating the marketing organization in percentage terms in various types of pharmacies
Product category Trading format CANDID, Glenmark (cream 10 mg/ml, 20 g) CANDID, Glenmark (solution for external application 10 mg/ml) CLOTRIMAZOL, Synmedic (ointment 1%) CLOTRIMAZOLE, BHFZ (solution for external application 1%) KANDIBEN, ratiopharm (cream 1%) CLOTRIMAZOLE BHFZ (ointment 1%) CANDID, Glenmark

CANDID, Glenmark (porous dermal, 1%) CLOTRIMAZOLE, GSK (cream 1%) CLOTRIMAZOLE, Fitopharm (ointment 1%, 15 g) CLOTRIMAZOL, Phytopharm (ointment 1%, 25 g) IMAZOL CREMPAST, Delta Medical (10 mg/g) CLOTRIMAZOL, Organosyn Life Sciences (ointment 1%)
1 (UAH 100 thousand) Closed 3. 6 0.5 8 11.2 14.4 8 0.2 50.5 1.4 2.3
Open 1.6 0.2 13.3 7.7 1.4 8.1 4 1 59 2.2 2.4 0.2
2 (UAH 250 thousand) Closed 1.8 1.3 12.3 7 2.1 13.3 4.1 0.7 51.1 2.1 3.4 0.7
Open 1.7 0.6 23.8 8.7 0.7 13.1 4.0 0.7 44.5 0.5 0.9 0.1 0.7
3 (UAH 450 thousand) Closed 1. 1 0.7 13.1 6.6 1.7 17.4 5.7 0.7 48.2 1.2 3.0 0.2 0.3
Open 1 1 12.9 7.9 2.1 17.5 6.8 0.8 47.5 0.6 1.6 0.2 0.1
4 (UAH 700 thousand and more) Closed 1 0.9 15.8 8.3 2.9 18.2 5.8 1.3 41.7 1.2 1.9 0.3 0.5
Open 0.7 0.6 10.7 8.5 3.3 22.9 6.8 1.5 41.3 0.9 2 0.5 0.3

A significant proportion of drugs with the active ingredient clotrimazole is low-margin. Thus, 88% of commodity items are characterized by an average marginal income from the sale of 1 package at the level of UAH 2.2. (Fig. 7).

Fig. 7

Share of consumption (pack) and marginal revenue of some SKUs of topical clotrimazole with marginal revenue per package as of May 2014

It is important to emphasize that at present, doctors practically do not prescribe clotrimazoles, but at the same time, their share in physical terms in the sales structure of drugs for the treatment of mycosis of the feet and nails is about 35%.

In other words, in this example, we see that Ukrainians buy most of all those drugs that today are practically not prescribed by specialized specialists.

At the same time, for pharmacies, the sale of these medicines is also not the most profitable, especially given the cost of logistics.

By changing the sales structure of category drugs towards higher margin positions, pharmacies can increase their income.

Terbinafine

INN terbinafine is included in the WHO List of Essential Drugs. In Ukraine, it is not included in the mandatory minimum range.

Terbinafine is the most prescribed INN for the treatment of foot and nail fungus, with 41% of all healthcare professional prescriptions for this active ingredient. The share in the overall sales structure in packages is more than 20%.

On the Ukrainian pharmaceutical market there are a number of drugs for topical use (17 commodity items, taking into account dosage forms), the active ingredient of which is terbinafine. Among them are generics and 1 original drug, which is marketed in our country under the trade name Lamisil.

In the sales structure of terbinafine drugs, the original drug occupies 20%, that is, it is every 5th drug dispensed among this INN drug. It accumulates 40% of the marginal income from the sale of terbinafine. The marginal income from the sale of 1 package of the original drug is UAH 36, while among generics this figure is at the level of UAH 13. The leader in sales in packages is the branded generic Lamicon. It accumulates more than 60% in physical terms among terbinafines, which corresponds to 46% of the marginal income from their sale (Fig. 8).

Fig. 8

Share of consumption (pack) and marginal revenue of some brands of topical terbinafine, showing marginal revenue per pack as of May 2014

Naftifin

Every 5th INN prescribed in Ukraine for the treatment of onychomycosis and foot mycosis is naftifine. This active ingredient in Ukraine is represented by 1 brand – Exoderil. The marginal income from the sale of 1 package of this medicinal product is UAH 20.

The share of Exoderil in the marginal income of the category of drugs for topical use in the treatment of mycosis of the feet and nails is 36%, which brings it to the leader position. In real terms, naftifine accumulates 23% of the sales volume of all medicines in the category.

Miconazole

Miconazole is on the WHO List of Essential Medicines. This molecule is listed as a representative of a pharmacological class of drugs that exhibit a similar clinical effect, and, in accordance with international information resources, is the lowest cost. In Ukraine, this INN is not included in the mandatory minimum range.

On the Ukrainian pharmaceutical market, 2 domestically produced drugs are marketed, the active ingredients of which are miconazole, Mikogel and Miconazole.

The average marginal income from the sale of 1 package of the drug for topical use, the active ingredient of which is miconazole, is 3 UAH.

Ketoconazole

The group of ketoconazoles is represented by drugs of domestic and foreign production. Among them is the original drug – Nizoral. The marginal income from the sale of one package of the original drug is UAH 26, while among generics the average figure is at the level of UAH 8. (Fig. 9).

Fig. 9

Share of consumption (pack) and marginal revenue of some brands of topical ketoconazole, showing marginal revenue per pack as of May 2014

The share of the original drug Nizoral in the sales structure of ketoconazoles is 17%, while it accumulates about 40% of marginal income.

The most consumed (purchased) drug among ketoconazoles – Dermazole – accumulates 50% of sales in physical terms and 40% of marginal income.

Also INN

In the category of drugs of group D01 for topical use in the treatment of mycosis of the feet and onychomycosis, such INNs as bifonazole + urea and sertaconazole are also presented.

In particular, the drug Kanespor (bifonazole + urea) is of interest. Kanespor is every 3rd topical drug prescribed by doctors for nail mycosis.

This drug belongs to the high-cost group, the marginal income from the sale of 1 package is 46 UAH.

According to data for March-May 2014, the volume of sales of this drug in packages is increasing. The volume of sales of this drug in physical terms in May 2014 increased by 28% compared to the same period of the previous year.

Sertaconazoles are also high-margin drugs actively prescribed by doctors. In Ukraine, for local use in foot mycosis, this active ingredient is represented by 2 brands – Zalain and Onabet. The marginal income from the sale of 1 package of these medicines is 26 and 17 UAH. respectively.

Despite the fact that sertaconazoles occupy the 2nd place in the structure of doctor’s prescriptions for foot mycosis, their share in the sale of drugs in the analyzed group in physical terms is only 2%.

what can be recommended to patients?

Topical preparations for foot fungus and onychomycosis are characterized by seasonal demand. At the same time, in warm months (there is a higher demand for drugs in the category), the number of recommendations for these drugs in pharmacies noticeably increases.

The first-desk pharmacist has a great responsibility: it is necessary not only to sell the drug, but to provide a full-fledged pharmaceutical care service.

Pharmacists can recommend drugs for the treatment of mycosis of the feet and nails based on the prescriptions of doctors, which are based on evidence-based medicine (Fig. 10). Some molecules are prescribed for both diseases, while others are prescribed for only one type of pathology. Thus, terbinafine and topical naftifine are indicated for the treatment of foot fungus and onychomycosis. Sertoconazoles and ketoconazoles are also prescribed for foot mycosis.

Fig. 10

Top 5 INNs in the structure of prescriptions by nosology (foot fungus and onychomycosis) according to Q2 data 2013 – I quarter. 2014

For onychomycosis, doctors most commonly prescribe INNs such as terbinafine, naftifine, and bifanosol + urea.

If a patient wants to buy a low-cost drug, he can also be recommended a drug whose active ingredient is miconazole (included in the WHO list).

General conclusions

On the Ukrainian pharmaceutical market there are several dozens of commodity items of the category of topical medicines for use in foot and nail mycosis (including dosage forms).

Among the drugs in the category, there is a certain “skew” between medical prescriptions and actual sales.

The INN most bought by Ukrainians (clotrimazole) is rarely prescribed by specialized specialists. In our country, this active substance is included in the mandatory minimum assortment. At the same time, the WHO List of Essential Drugs includes other INNs for topical use in fungal skin diseases: terbinafine and miconazole.

The most prescribed INNs for foot and nail mycosis are terbinafine, naftifine, sertoconazole and bifonazole + urea.

The recommendation in pharmacies of drugs containing INN data is economically justified for pharmacies, since among them there are high-margin commodity items.

Changing the sales structure towards higher-priced ones will allow pharmacies to increase marginal income from drugs in this group.

The sale of low-margin commodity items is the reason why pharmacies actually receive less profit. And although they are health care institutions, they still operate in a market economy. In no case should you forget about the need to make a profit.

The formation of a product range taking into account the market characteristics of medicines allows pharmacies to fulfill their social function, providing quality pharmaceutical care to patients, not forgetting their own profit.

Best practices such as Category Management can help pharmacies with this.

In the next issues of the “APTEKA Weekly” we will provide an analysis of other categories of goods in the pharmacy basket.

You can send your wishes about the choice of categories for analysis to the address: [email protected] or by phone: +38 (044) 585-97-10.

Galina Galkovskaya,
references are in edition

Mycosis of the feet – St. Petersburg State Healthcare Institution “Dermatovenerological Dispensary No. 4”

Mycosis of the feet – fungal infection of the feet, the main pathogens of which are Trichophyton rubrum, Trichophyton mentagrophytes var. Interdigital.

Infection occurs through direct contact with a sick person or indirectly, through objects infected with the fungus. The skin scales of a patient with mycosis of the feet can stay for a long time in the premises of baths, showers, locker rooms, on rugs, wooden bars, shoes, while maintaining their viability. The main condition for infection is a violation of the integrity of the skin of the feet (with increased sweating of the feet, the presence of corns, various deformities of the feet). Predisposing factors are: obesity, as a result of which the load on the foot increases, resulting in microcracks, microtraumas; the presence of type 2 diabetes mellitus, in which the epidermal barrier is also damaged due to malnutrition and tissue regeneration.

There are 3 main forms of mycosis of the feet:

  • squamous;
  • intertriginous;
  • dyshidrotic.

The squamous form is more often localized on the plantar surface of the feet, often accompanied by damage to the nails. Affected skin is usually pinkish in color, thickened and covered with small scales. Dryness and peeling are noted in the interdigital folds. Moderate itching is subjectively noted.

In the intertriginous form, interdigital folds are affected, more often between 3rd and 4th, 4th and 5th toes. The process is characterized by redness, swelling, maceration, erosion and cracks are often formed. Subjectively marked itching, burning, soreness.

In the dyshidrotic form, the lesion is localized in the area of ​​the arch and on the lateral surfaces of the foot. It is represented by multiple bubbles that can merge with each other and form erosion when opened. Subjectively, itching, burning, soreness is felt.

The diagnosis of mycosis of the feet is confirmed by laboratory (microscopic). To determine the type of pathogen, a cultural study is carried out.

For the treatment of athlete’s foot, mainly topical antifungal therapy is used. Particular attention should be paid to disinfection (treatment of shoes, socks). To prevent mycosis of the feet, it is necessary to follow the rules of personal hygiene, take care of the skin of the feet to prevent abrasions, microtraumas, and monitor comorbidities.

In the event of rashes on the skin of the feet, you do not need to hesitate, use antifungal drugs yourself, but you need to seek help from a dermatovenereologist, who will give the necessary recommendations for the care, treatment and prevention of the disease individually in each case.

Long-term treatment: foot fungus is treated for up to 1.5 months.

With mycosis of the feet, it is necessary to timely and completely cure the fungus with control studies. However, during treatment0528 recommended : wear cotton socks, change them daily and store separately, wash with hot water, boil or iron, shoes should be treated with UV dryers. The patient must have individual nail scissors, their disinfection is carried out over the flame after use. It is necessary to periodically treat the floor with disinfectants, carry out steam cleaning of carpets, keep the bathtub / shower cabin clean, and disinfect it before each use.

Reinfection is possible after treatment. To prevent re-infection, preventive measures are necessary: ​​

  1. Compliance with personal hygiene rules (daily foot care, use of individual towels, socks, shoes, bath and shower disinfection).
  2. Use comfortable shoes made from natural materials, in summer favor well-ventilated, open-toed shoes.