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From: sdyer@bbncc5.UUCP (Steve Dyer)
Newsgroups: net.med
Subject: Re: athlete's foot
Message-ID: <556@bbncc5.UUCP>
Date: Mon, 26-Aug-85 18:37:15 EDT
Article-I.D.: bbncc5.556
Posted: Mon Aug 26 18:37:15 1985
Date-Received: Wed, 28-Aug-85 21:20:03 EDT
References: <440@sdcc12.UUCP>
Organization: Bolt Beranek and Newman, Cambridge, MA
Lines: 57

> Help!
> For nearly two years now I have been battling athlete's foot
> between the same two toes and I can not get rid of it.  I have tried 
> nearly every over-the-counter medication ... without success.
> I am beginning to wonder if it perhaps even thrives on these ointments.

I can add my own recent experience with a case of tinea cruris so bad that
Tom Stanions might even describe me as "dying of accute jock itch." :-)
I had the same unsuccessful experience with most OTC preparations--I was
practically bathing in Tinactin, and if anything, the condition was
getting worse.  Luckily my doctor at my local HMO suggested a 
several-point approach, and things are improving rapidly.  Athlete's foot
and jock itch are caused by the same fungi, and they share many of the
same symptoms and treatment.

First, KEEP THE AREA DRY.  These fungi like their home warm and wet.
Generally, this means ensuring that perspiration doesn't collect around the
area: for athlete's foot, this means avoiding tight shoes, applying powder
to adsorb moisture, etc.  For jock itch, changing from jockey shorts to
boxer shorts (ugh), using powder.  Also, you'd be amazed at how much
moisture remains after thorough towelling after a shower.  My doctor
suggested lying for 15 minutes beneath a 100 watt bulb 1 foot from my,
ahem, affected area.  I compromised and am now using a hair dryer set to
low heat.  I've also found that cornstarch is tremendously adsorbent
and, unlike talc, you don't have to worry about inhaling the stuff.

Second, use an effective medicine.  That means not bothering with fungistatic
creams like Desenex (undecyclenic acid).  You want something that will
kill the fungi.  Tinactin (tolnaftate 1%) has been the most popular OTC
treatment for several years, but it turns out that it has only about
a 60% cure rate.  If it works, great, but this latest case of mine was
too much for it.  My doctor prescribed another antifungal agent,
clotrimazole, in a cream.  This is available only by prescription.
It turns out, however, that a related drug, possibly even more effective,
is now available without prescription: it's miconazole, available as a
cream under the name "Micatin".  In clinical studies, it achieved a 95%
cure rate in jock itch and athlete's foot.  This is perhaps the best
showing in topical antifungal drugs.

Third, don't stop treatment too early.  Most of us (myself included)
when faced with JI or AF simply slap on some gunk, and hope it goes
away, and usually it does, or at least the flare-up is taken care of.
Unfortunately, some viable fungi remain, and the next time the environment
gets too favorable, POW!  I'm in the first week of a four week regimen,
and I intend to keep up the treatment for the full four weeks, even though
clinically, everything feels just fine now.  And, of course, even after
successful treatment, prophylactic measures (keeping the area dry, adequate
hygiene around pools and shower rooms, etc.) are still called for.

Finally, in some really BAD cases, there is also an oral medicine known
as griseofulvin, which may be useful.  It has enough side-effects
that most doctors don't prescribe it casually, and the topical
agents generally work as well or better, when they work at all.
-- 
/Steve Dyer
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