The ‘super foot fungus’ – Drug resistant fungal foot infections are presenting podiatrists with more of a clinical challenge. In October 2017, I wrote a blog raising the issues of treatment resistant fungal nails with biofilms. Fungal biofilms are similar to those bacterial ones found in the body which are resistant to antibiotics.
It was first brought to my attention in 2017, by the US Podiatry Today journal regarding the difficulties of treating treatment resistant dermatophytomas. Having been a specialist in the treatment of fungal nail pathologies for many years it was an eureka moment. I had personally observed that it was getting increasingly hard to treat long standing onychomycosis in some patients, despite the best efforts of both parties; patient and clinician. The success rates were going down. When I say success rate; that is a complete resolution of both skin(Athlete’s Foot) and nail infections for any length of time.
I noted re-infection rates for fungal nails after a course of Lunula laser, topicals, oral medication were creeping up. This was becoming increasingly frustrating and perplexing. The arrival of the super foot fungus was here! I was seeing more posts from other podiatrists experiencing similar issues. What was going on?
Ethan Ennals, writing for The Mail on Sunday May 2023, wrote an article exploring the subject; ‘ Even the strongest of Athlete’s Foot cream on chemist shelves is becoming useless’ :
“Much has been written about bacterial infections that are resistant to antibiotics – making once treatable conditions like urinary tract infections potentially lethal. But experts are seeing a similar pattern with everyday fungal infections. And there are fears the NHS could soon run out of effective treatments.”
It is very important to break the cycle of fungal infections, ensuring that all the infective dermatophytes, especially the spores are effectively eradicated. A successful treatment involves treating the skin, the nails and the environment e.g. footwear. No point just applying cream to the skin and hoping for the best. It takes a lot of time and dedication to achieve a optimal result. Unfortunately, NICE recommended topicals like Lamisil (Terbinafine Hydrochloride), which we recommend as part of a treatment regime, are becoming increasingly ineffective. Fungus like bacteria can evolve to develop stronger defence mechanisms against the drugs designed to eradicate them. Treatment choices get narrowed down. The patient’s own particular fungal infection is impervious to conservative treatments.
Last year I asked a colleague going to a Podiatry Dermatological conference, to ask the eminent presenting Professor, why patient’s developed treatment resistance? Apparently, he could not elucidate on this emerging issue. In reality very little research is being focused on this subject. In 2014, scientific advisors to the European Commission, advised removing anti-fungal ingredients from cosmetic products to try and slow down emerging fungal resistance, but this has not happened. It has with over-prescribing antibiotics, but dermatological skin/ nail fungal infections are not considered as important.
At Compleet Feet Podiatry,we have to work extra hard with our patients to successfully resolve treatment resistant infections. Often it is better to completely remove a diseased nail and allow it to grow back healthy. This will only work if all cycles of infections are addressed. If there is an accompanying drug resistant entrenched Athlete’s foot infection, it is much more challenging. New drugs need to be developed. The quicker patients seek help, the easier it is to treat. Time is of the essence. The ‘super foot fungus’ must be stopped in it’s tracks.
