Abstract
In hyperkeratotic type tinea pedis, a sufficient curative effect is generally not obtained with topical antimycotic agents alone, because the main symptom is plantar keratosis. Oral antifungal drugs, such as itraconazole and terbinafine, are useful for treating hyperkeratotic tinea pedis in patients who can orally ingest drugs. In patients who do not respond to oral antifungal agents, we recommend the combination of an oral antifungal agent (such as itraconazole or terbinafine) and a topical antifungal agent, although problems may be encountered in obtaining reimbursement under the Japanese health insurance system. If oral administration is impossible, various topical application methods, such as concurrent use of urea ointments and the use of occlusive dressing technique, can be tried. In any case, it is important to continue treatment without losing hope. Combination therapy with oral and topical antimycotics is considered the most effective treatment. I generalized including domestic and foreign reports, and I pointed out problems, mainly regarding the cure for disease in consideration of the pharmacokinetics in the stratum corneum. In the future, we hope to see the development of more oral and topical antifungal agents that have fewer systemic adverse effects (in particular, hepatic disorders), have interactions with other drugs, and are transferred to the skin at higher concentrations. Treatment regimens (including dosage and treatment period) for existing drugs will also have to be reviewed in multicentre clinical trials.
