TINEA --------------------------------------------- What is your advice about the treatment or trashing of fomites when you prescribe topical or po antifungals for l. Tinea Pedis (shoes, carpets, shower stalls etc 2. Onychomycosis (ditto 3. Tinea Capitis (telephones, hairbrushes, caps, sofa backs, car seats , toys etc Thanks for any ideas. I was thinking we all probably overlook one thing or another. Diane Thaler -------------------- Sometimes it is useful to shampoo the rugs with (what else?) Nizoral shampoo. I had a lady who go tinea corporis from working out on the bedroom rug that her husband (with tinea pedis) walked on. Kevin C. Smith MD FRCPC -------------------- What is cost accounting? One or two bottles of Nizoral shampoo is enough to do a bedroom rug. Kevin C. Smith MD FRCPC -------------------- Doesn't it have red dye in it-atleast it looks red. Diane Thaler -------------------- Actually we just use 10% folmalin solution and just wipe the inside of the shoes using the newspaper. The lingering smell of formalin doesn't last for more than a day. Cheap! Jonathan Nevin Yu, MD -------------------- Has anyone considered the issue of fomites with HPV and post-treatment re-exposure to shoes, gloves, other clothing, furniture or floors? Ronald Johnson, M.D. -------------------- Shampoo with Nizoral??? At what cost? Sure wouldn't want that on my cost accounting! Last I checked, it was $17 for a 4-oz bottle, and that was years ago. Barbara R. Reed, MD ------------ How do you normally treat bilateral, KOH-positive, dry-hyperkeratotic type of T. manum? I have a 45 y.o. WM who has been on 1g Gris-peg for 3 months. He's not scaling much, but still hyperkeratotic. He's happy! I'm not. How long can this go on? Should I try something else. Andrews textbook mentioned taking at least 6 months to clear on Gris-Peg. Tom McGovern ----------- I would use intraconazole for 2 weeks at 400/day based solely (no pun intended) on clinical experience-but check for feet and toes in case you need to do the pulse monthly dosing. And I would use acid moisturizer such as ammonium lactate (Lachydrin) or glycolic (Aqua Glycolic). T. Manum is always so rewarding to diagnosis because its seems the poor guys (never saw a gal with it) have had it forever and are so excited when it goes. Diane Thaler ----------- any tinea manuum on Griseofulvin at that dose for 3 months should be KOH negative. If it is , I'd use keratolytics first (Lactinol-E cream under occlusion h.s.). If the KOH is positive, then you know what to do; but do a KOH first. John Uhlemann. MD ------------- I recommend Tigason 25 mg bid for 1 week and then quit for 3 weeks. Wait for the dramatic desquamation (usually a thick large lamellated scale). If it doesn't work, repeat the remedy. I haven't try it on tinea manum. However, it works dramatically in aquired hyperkeratosis of palms and soles. Are there anyone on line have similar experience? TAK-WAH WONG M.D. -------------- Itraconazol and Terbinafine are good options (systemic terbinafine yet unavailable in US?), but why don't you also try to add topically the old Whitfield 's formula (even half strength?). It has worked for me pretty well, in tinea pedis. George Leal --------- After peeling of thick hyperkeratotic scale, it's a easy task to control the condition with classic emollents/keratolytic agents. It usually free of disease for months. I've just started this preliminary trial in a few cases. I will post the result after a long term follow up. TAK-WAH WONG M.D. -------------- How about this for a cheaper version? Use 2% miconazole cream( generic Micatin, Monistat-derm, etc.) with Robinul 1mg/gm . Should also work for intertrigo. If you want a powder, you can compound the Robinul in the same percentage into Zeasorb AF powder or the antifungal powder of your choice. Also not a bad way to go for intertrigo. E. Zabawski ---------- Had another patient with sweaty feet and tinea pedis for years come back ultra-pleased after applying Lamisil cream with Robinul (glycopyrrolate) 1 mg / gm for a month daily after bathing. This will be continued long-term prn. Glycopyrrolate 1 - 2 mg / gm greatly reduces sweating in many cases, making the patient more comfortable and also making it harder for tinea to get a "foothold". Kevin C. Smith MD >> According to my PDR the maximum recommended adult dose for Robinul is 8mg per day. I love KC's brilliant and innovative ideas, but check the doses for missing decimal points! Walter H. Wood, M.D. -------------- The dose IS 1 mg of Robinul per gram of Lamisil cream. As a rule of thumb 1 gram of cream will cover 1% of the body surface area, so putting the cream between his toes is using less than 1 gram of cream per day (exposing him to less than 1 mg of Robinul per day). Sorry if I didn't make that clear. I have not had any problems using Robinul up to 2 mg / per gram of cream for things like intertrigo and hyperhydrosis of the palms and soles, probably because: the total amount of cream has been low systemic uptake of Robinul has been considerably less than the amount applied to the skin systemic uptake has been more gradual than you would get with an oral dose, so that the blood level would be both lower and more stable. I agree with the suggested alternatives for long term therapy -- but my patient is happy, cost is no object for him, and he wants to leave well enough alone. Kevin C. Smith MD ---------- In my opinion, almost everyone who has "one-hand, two-foot disease" also suffers from atopic dishidrotic ezcema, (which is why they get hand fungus in the first place) so he may have hand dermatitis that is continuing. I would KOH and culture him to be sure you have cured him mycologically though before you stop the antifungal treatment. Another possibility to consider is that he hasn't taken the medication because of some secondary gain situation. Mark Naylor, M.D. ------------- In non or partial responders to griseofulvin, I have had a lot of success switching the patient to 200mg/day of Sporonox, for one or two months. Gary Salenger M.D. ------------ Maybe 100mg BID would lead to higher tissue levels and faster cures. Mine have cleared in one week. Diane Thaler ----------- I coauthored the paper "Tea tree oil in the treatment of tinea pedis" (Australasian Journal of Dermatology 1992;33:145-149). Tea tree oil reduced the symptoms of tinea pedis (scaling, inflammation, itching and burning) as effectively as tolnaftate 1% but was no more effective than placebo in achieving a mycological cure. This may be the basis for the popular use of tea tree oil in treating tinea pedis. A colleague, Dr. Ingrid Bassett, compared tea tree oil to benzoyl peroxide in the treatment of acne vulgaris and found it to be as effective (Medical Journal of Australia 1990;153(8):453-8). Melinda Tong, MRCP --------------