怎样治疗足癣

如何治疗足癣配图，仅供参考

Treatment
General measures
Because fungi thrive best in moist warm environments,patients should be advised to wear non-occlusive,clean,natural fibre or cotton socks and shoes (ideally,sandals) and dry their feet thoroughly after bathing. Prolonged use of occlusive footwear should be avoided. The importance of proper washing of the feet,good personal hygiene,avoidance of footwear sharing and proper disinfection of footwear of affected patients cannot be over-emphasized. In one study,Trichophyton species was detected from the footwear of 47% of patients with tinea pedis. If necessary,footwear of affected individuals can be sterilized by ultraviolet-C (UVC) sanitizing devices and ozone gas.,Some authors suggest disinfection of socks by soaking in quaternary ammonium compounds. Hot washing of socks or running shoes can also kill fungus. Application of desiccating,antiseptic powders to the feet (particularly between toes) as well as the footwear may help.,Hyperhidrosis of the feet should be treated appropriately.
Topical antifungal therapy
Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis. Topical antifungal agents are generally applied once to twice daily for 1–6 weeks (usually 2–4 weeks) depending on the severity of the lesion,the type of medication used and the response of the lesions to treatment.,A variety of topical antifungal agents are available for the treatment of tinea pedis,including azoles (e.g. econazole,ketoconazole,sertaconazole,efinaconazole,miconazole,clotrimazole,luliconazole,isoconazole,oxiconazole,sulconazole,tioconazole),allylamines (e.g. naftifine,terbinafine),benzylamine (e.g. butenafine),ciclopirox,tolnaftate and amorolfine. – It has been shown that patients with interdigital tinea pedis usually respond to 1 week of treatment with topical terbinafine whereas those with hyperkeratotic tinea pedis may require treatment for 4 weeks. In a mixed-treatment comparison (head-to-head trials and trials with a common comparator) meta-analysis involving 14 topical antifungal treatments,there was no significant difference in the efficacy amongst the antifungal agents. A 2022 systematic review of seven randomized controlled trials (n=680) showed that the likelihood of successful treatment of tinea pedis with topical terbinafine and topical butenafine was 3.9 (95% CI 2.0–7.8) and 5.3 (95% CI 1.4–19.6) times that of patients treated with a placebo,respectively. Topical terbinafine and topical butenafine had similar efficacy. Topical nystatin is not effective for the treatment of tinea pedis and is therefore not recommended. As topical ciclopirox has antidermatophytic,anticandidal and antibacterial activities,the medication is particularly effective for the treatment of dermatophytosis complex.,Other topical antifungal agents that have antibacterial activity include miconazole,sulconazole and naftifine. Topical antifungal agents are well tolerated. Side-effects are uncommon and consist mainly of pruritus,stinging and burning sensation at the site of applications.,Most of the relapses are a result of poor compliance,which is more commonly seen in patients/parents who are working long hours or individuals taking multiple medications; these individuals tend to discontinue the medication prematurely if there is no response (not enough time for the medication to work) or with partial cure. In this regard,topical antifungals,such as sertaconazole,terbinafine and econazole,which can be used once daily,may help to improve compliance.,Terbinafine 1% cream might be the best strategy for maintaining remission,especially for the treatment of interdigital tinea pedis.,Resistance to terbinafine therapy may be due to infection with non-dermatophyte moulds or infection with a dermatophyte that has acquired resistance to terbinafine. Acquired resistance to terbinafine may be due to a missense mutation in the squalene epoxidase-encoding gene.,Squalene epoxidase is an enzyme involved in ergosterol synthesis,which is a target for terbinafine.,Use of a special carrier system where topical antifungal agents are attached to carriers (e.g. noisomes,liposomes,ethosomes,nanostructured lipid) to enhance their ability to penetrate the stratum corneum and to increase their bioavailability opens the door for future research in this area.,New formulations of topical antifungal agents that may enhance the efficacy and,potentially,compliance include BB2603 (a nano-formulation of terbinafine with the polymer polyhexamethylene biguanide to enhance solubility and drug delivery to the skin) and a miconazole–urea combination (claimed to potentiate the spectrum of antifungal activity whilst reducing the chance of drug resistance).
Systemic antifungal therapy
Systemic treatment should be considered if the condition is extensive,recurrent,chronic or resistant to topical antifungal treatment,if the patient is immunocompromised,or if there is evidence of concomitant onychomycosis.,Oral antifungal agents used for the treatment of tinea pedis include terbinafine (62.5 mg/day for body weight 10–20 kg,125 mg/day for body weight >20 kg and