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Evidence summaries

Topical Treatments for Fungal Infections of the Skin and Nails of the Foot

Allylamines, azoles and undecenoic acid are effective for Fungal Infections of the skin of the foot. Allyllamines appear to be slightly more effective than azoles. Evidence for the management of topical treatments for infections of the toenails is sparser. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 64 studies. Placebo-controlled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 - 0.70). Meta-analysis of 11 trials comparing allylamines and azoles showed a risk ratio of treatment failure RR 0.63 (95% CI 0.42 to 0.94) in favour of allylamines. There is some evidence that ciclopiroxolamine and butenafine are both effective in the treatment of toenails, but they both need to be applied daily for prolonged periods (at least 1 year). The 6 trials of nail infections provided evidence that topical ciclopiroxolamine has poor cure rates and that amorolfine might be substantially more effective but more research is required.

    References

    • Crawford F, Hollis S. Topical treatments for Fungal Infections of the skin and nails of the foot. Cochrane Database Syst Rev 2007;(3):CD001434 [PubMed]

Primary/Secondary Keywords