However, most patients with symptomatic dermatophyte infections in such restricted areas as the feet, groin, or glabrous skin obtain rapid relief with readily available and usually less expensive store-shelf remedies. These compounds must be applied not only to the affected area but also to a swath of skin about 1 in. beyond clinical involvement. Patients should be instructed that these preparations must be applied for a week or more after apparent remission, not just until symptoms abate. Insufficient treatment duration only temporarily injures the fungi and practically guarantees recrudescence. In fact, many supposedly resistant infections represent nothing more than failure to comply with or understand treatment instructions.
More expensive regimens achieve only a slightly improved mycologic cure rate.
Topical preparations even cure up to half of all diseased nails, provided that involvement remains minimal. Extensive cutaneous dissemination, greater degrees of nail dystrophy, scalp or hair disease, or immunosuppression suggests a need for oral therapy. Curbside Consults brings the consultant to you. Send us your question. If its answer would be of value and interest to our audience of primary care physicians, you may see it in an upcoming issue.