Why Address Fungal Infections in Podiatry?

Fungal infections are true infectious diseases, not mere cosmetic issues. They present a significant challenge in podiatry, demanding a comprehensive understanding and effective management strategies.

“The saga of available treatments for fungal infections of the lower extremity has been like being on a roller coaster ride” - Warren S. Joseph, DPM FIDSA, Handbook of Lower Extremity Infections, 2009.

What is Onychomycosis?

Onychomycosis, also known as nail fungus, is a fungal infection of the nails that often starts as a skin infection. The primary fungi responsible for onychomycosis are dermatophytes, which include:

1. Trichophyton

• T. rubrum
• T. mentagrophytes
• T. tonsurans

1. Microsporum

• M. audouinii

1. Epidermophyton

• E. floccosum

TINEA PEDIS

It is probably the most common infection seen in the lower extremity. It is estimated that almost 15 % of the population has a “foot infection” each year.

A dictionary definition of Tinea Pedis is an infection of the skin of the feet caused by the dermatophytic fungi, Synonyms include: Athlete’s Foot, Ringworm, Dermatophytosis, and Dermatomycosis.

Natural Reservoirs of Dermatophytes

• Anthropophilic: Natural pathogens of humans.
• Zoophilic: Natural pathogens of animals.
• Geophilic: Organisms found in the soil.

Who is at Risk?

1. Genetics: There is a genetic predisposition to fungal infections. An increase in regulatory T cells may hinder the clearance of dermatophytes, leading to onychomycosis.
2. Anatomy: Conditions like "kissing corns" due to insufficient space between toes can foster fungal growth.
3. Environment and Climate: Moist climates, such as those in Australia and New Zealand, contribute to higher incidences of fungal infections.

FUNGAL INFECTIONS

Fungal Infections are true infectious diseases, not simple cosmetic problem...

A list of common fungal infection conditions that can affect humans:

1. Athlete's foot (Tinea pedis)
2. Ringworm (Tinea corporis)
3. Jock itch (Tinea cruris)
4. Nail fungus (Onychomycosis)
5. Yeast infection (Candidiasis)
6. Diaper rash (Candidiasis)
7. Oral thrush (Candidiasis)
8. Vaginal yeast infection (Candidiasis)
9. Aspergillosis
10. Histoplasmosis
11. Coccidioidomycosis (Valley fever)
12. Blastomycosis
13. Cryptococcosis
14. Pneumocystis pneumonia (PCP)
15. Dermatophytosis (skin, hair, and nail infections)
16. Keratomycosis (corneal infection)
17. Otitis externa (fungal ear infection)
18. Fungal sinusitis
19. Fungal meningitis
20. Fungal endocarditis (heart valve infection)

3 True Facts in Podiatry Field: Onychomycosis and Tinea Pedis

1. 80% of patients with onychomycosis have a history of Tinea Pedis
2. Onychomycosis begins with skin infection and/or Nail Trauma
3. Comprehensive treatment is crucial

So Who gets Fungus?

1.Genetics play a huge role, it's not just about walking barefoot in public areas or being constantly exposed to moisture, sweat, constrictive shoes. 

There is a genetic predisposition to develop fungal infections! Research shows that an increase in Regulatory T cells may play a role in failure of clearance of dermatophytes from skin…which leads to development of Onychomycosis

2. Your Anatomy 

Have you ever heard of “kissing corns”? Some people just do not have room between their toes, which prevents the air from circulating adequately, moisture builds up well and the pressure of being stuck! Hence why corns form .. and then they kiss:)..

3. Environment and Climate

Moisture of the skin leads to easy access to the stratum corneum allowing fungal invasion. Living in Australia or New Zealand, such a large proportion suffer with fungal complaints, especially here in the tropics.

 Diagnosing Fungal Infections in Podiatry

 Podiatrists rely on two primary methods for diagnosis:

1.Clinical Observation

Podiatrists are trained to recognize the characteristic signs and symptoms of fungal infections, including discoloration, thickening, and brittleness of the nail, as well as skin lesions and scaling.

2.Pathology Testing

While clinical observation is essential, pathology testing provides definitive evidence of fungal infection. Two common methods are:

• KOH Preparation: Although useful, KOH preparation has limitations, including a prolonged processing time (weeks) and potential inaccuracies.
• Fungal Culture: The Dermatophyte Testing Medium (DTM) is the preferred method for fungal culture. DTM involves placing skin scrapings or nail clippings in a specialized jar. If the medium turns red, it indicates the presence of a dermatophyte, confirming the diagnosis. This simple yet effective test is a valuable tool in diagnosing fungal infections.

 The Challenge of Treating Nail Fungus: High Recurrence Rates

Over-the-Counter (OTC) vs Prescription (Rx) Products vs Laser Therapy

 Various over-the-counter (OTC) topical antifungals that podiatrists go with are: Loceryl, Rejuvenail, Emtrix, MycoNail, and Tea Tree oil, are all readily available at pharmacies without a prescription or our consultation. However, their efficacy is limited, as demonstrated by a study showing Ciclopirox 8% (Rejuvenail) achieves a success rate of only 12%. The high failure rate leads many patients to abandon treatment, allowing the infection to progress and potentially result in total nail dystrophy (TDO) if left untreated.

 When it comes to treating nail infections, creams are not effective. However, nail lacquers like Loceryl, containing Amorolfine as the active ingredient, are widely recommended by General Practitioners (GPs) and podiatrists in Australia. Loceryl is a popular choice among healthcare professionals for combating fungal nail infections. (Amorolfine 5% lacquer was shown to have a mycologic cure rate of 8% in a small randomized controlled trial (RCT) with 24 patients)

Oral Antifungals: Medications like Terbinafine can be effective but come with potential side effects such as nausea, taste disturbances, and hepatotoxicity. They are also costly, and concerns about efficacy and side effects often lead to resistance from both patients and healthcare providers. Recent Study Showed permanent nail damage post treatment

 ORAL Terbinafine Side Effects:

• Vomiting
• Diarrhea
• Stomach pain
• Headache
• Fatigue
• Skin rash
• Taste disturbance
• Hair loss
• Muscle pain
• Joint pain
• Liver problems

Laser Therapy: Laser treatments have emerged as a minimally invasive alternative for onychomycosis. These include:

• Hot (Thermal) Laser: Uses heat to destroy the fungus, typically requiring around an hour per session.
• Cold Laser: Employs two cold laser beams to damage the fungus and boost immune response, with sessions lasting about 15 minutes per foot.
• Lunula Laser: Utilizes dual-diode Class 2 lasers producing wavelengths of 635 nm and 405 nm, with potential for effective fungal treatment in a few sessions.

While laser therapy shows promise, the high likelihood of recurrence remains a significant drawback. Despite visible improvements, fungal infections often reoccur, causing frustration and financial burden for patients.

Recurrence Rates: A Persistent Issue

Studies indicate that recurrence rates for nail fungus range from 20% to over 50%, even after successful treatment, with many patients experiencing a relapse within a year or two

Factors Contributing to Recurrence:

• Fungal Spores: Dormant spores in the nail bed or surrounding tissues can reactivate under favourable conditions, such as a damp environment in shoes.
• Poor Foot Hygiene: Inadequate foot hygiene and chronic hyperkeratosis can foster fungal growth.
• Genetic Predisposition: Some individuals may be genetically more susceptible to fungal infections.
• Age and Health Status: Older adults and those with compromised immune systems are at greater risk of recurrence.

Breaking the Cycle of Recurrence

 The Role of Footwear Sprays in Fungal Treatment

It's important to recognize the limitations of commonly used sprays like Tea Tree and Eucalyptus when it comes to eliminating pathogens in footwear. While these sprays might temporarily mask odours, they do not provide a long-lasting solution to the underlying problem.

Tea Tree and Eucalyptus Sprays:

• Odor Masking: These sprays are primarily effective at temporarily neutralizing odours. However, their effect is fleeting, and they do not address the root cause of the odor, which is often microbial in nature.
• Limited Antimicrobial Action: While Tea Tree and Eucalyptus oils have some antimicrobial properties, they are not potent enough to eliminate fungal pathogens completely. They do not kill pathogens on contact and their efficacy diminishes rapidly.

Antimicrobial Performance of Clean Sweep® Antimicrobial Shoe Shield® Developed by the Tetra Corporation

Combination therapy

To combat the high recurrence rates, it's essential to adopt a comprehensive approach Using a combination of laser treatments, clinically proven and effective topical applications, and foot/shoe hygiene may improve treatment outcomes. Use Clean Sweep® in conjunction with laser treatments and topical applications for comprehensive treatment.

Clean Sweep® is a revolutionary shoe shield that utilizes antimicrobial technology to prevent the growth of fungi, bacteria, and viruses. This innovative product is designed to sanitize shoes and prevent the spread of infections.

Clean Sweep® is a revolutionary shoe shield that utilizes antimicrobial technology to prevent the growth of fungi, bacteria, and viruses. This innovative product is designed to sanitize shoes and prevent the spread of infections.

What Published Literature Tells Us About Nanosilver

Nanosilver: A Revolutionary Antimicrobial Agent

Nanosilver, or silver nanoparticles (AgNPs), has garnered significant attention in various industries due to its potent antimicrobial properties.

According to Santos et al. (2015), the characterization and antimicrobial properties of Clean Sweep® Antimicrobial Shoe Shield® on shoe materials were investigated.

The product is designed to eliminate 99.9% of odor-causing bacteria and fungus on contact, making it an essential tool for maintaining foot hygiene. Its antimicrobial performance was evaluated against test microorganisms such as Escherichia coli, Staphylococcus aureus, Candida albicans, T.Rubrum , Mentagrophytes and Aspergillus niger.

To effectively combat high recurrence rates, adopting a comprehensive approach is essential:

• Combination Therapy: Integrating laser treatments with clinically proven topical applications and maintaining rigorous foot and shoe hygiene can enhance treatment outcomes.
• Sanitization of Footwear: Using products like Clean Sweep® to disinfect shoes can prevent fungal spore survival and reduce the risk of reinfection.

The Importance of Treating Your Shoes: Introducing Clean Sweep® Antimicrobial Shoe Shield

• Nanosilver Technology: Unlike Tea Tree and Eucalyptus sprays, Clean Sweep® utilizes nanosilver, a powerful antimicrobial agent that attacks germs at multiple levels - disrupting respiration, replication, and cell wall synthesis.
• Comprehensive Pathogen Elimination: The nanosilver component ensures that microorganisms causing odor and fungal infections are effectively neutralized, not just masked. This results in a more thorough and lasting sanitization of footwear.
• Preventing Recurrence: By actively targeting and eliminating the root cause of the problem, Clean Sweep® reduces the likelihood of recurrence, providing a more reliable solution for patients struggling with nail fungus.

Elevate Your Practice with Our Exclusive “Dispensed by Podiatrists Only Program”

Benefits of the Program

• Control Over Treatment Outcomes: By dispensing treatments directly, clinicians can ensure better adherence and effectiveness.
• Revenue Opportunities: Reduce missed revenue opportunities by offering treatments directly through your practice.
• Clinical Excellence: Provide patients with clinically proven and effective treatments dispensed exclusively through registered practitioners.

 HOW TO BECOME A PROVIDER

1. Visit www.gotfungus.com.au to subscribe.
2. Join our exclusive provider program and revolutionize your practice.
3. Provide your patients with the highest quality care using Formula 3® Antifungal and Clean Sweep®

“Dispensed Exclusively through Podiatrists, General Practitioners, Dermatologist and Pharmacists”

Conclusion

By understanding the complexities of Nail Fungus as well as Tinea treatment and implementing a multifaceted strategy that includes effective footwear sanitization, patients can improve their chances of achieving long-term success and minimizing the likelihood of recurrence. Clean Sweep® stands out as a superior option for podiatrists seeking to provide their patients with a comprehensive and lasting solution to fungal infections. Podiatrists must be equipped with the knowledge and tools to diagnose and treat these infections accurately, breaking the cycle of recurrence through a comprehensive treatment approach.