Athlete’s foot can become “untreatable” with even the strongest over-the-counter creams, due to the rise of drug-resistant strains of the insect that causes the common skin infection.
One of the most widely used drugs, Lamisil Once, was able to combat the condition with a single dose when it was launched in the 1990s, but a growing number of patients are finding the remedy useless, experts say.
And concerns aren’t just about athlete’s foot, which causes the skin between your toes to become painful and cracked. One doctor said antifungal treatments are now ineffective in about a third of all the skin infections he treats.
Athlete’s foot is caused by a type of fungus called dermatophytes which also causes ringworm characterized by red, scaly, painful rashes that can appear anywhere on the body. These infections affect millions of people in the UK every year.
Much has been written about antibiotic-resistant bacterial infections that make once-treatable conditions like urinary tract infections life-threatening.
Athlete’s foot can become “untreatable” with even the strongest over-the-counter creams, due to the increase in drug-resistant strains of the insect that causes the common skin infection
But experts are seeing a similar pattern with everyday fungal infections. And there are fears that the NHS could soon run out of effective treatments.
“We’re seeing more and more drug-resistant fungal skin infections, and frankly, the issue hasn’t received enough attention,” says Dr. Neil Stone, consultant in infectious diseases and microbiology at University College London Hospitals NHS Foundation Trust.
“These types of problems are very prevalent and if the treatments we rely on stop working, this is going to be a huge health problem with huge ramifications.”
About 15% of people have had a fungal skin infection in the past year. The scaly, red rashes are much more common in older adults, affecting about half of people over the age of 70.
The drug recommended by the NHS for the treatment of athlete’s foot is terbinafine, the active ingredient found in Lamisil Once and other over-the-counter treatments. But this is one of the drugs that are becoming increasingly ineffective, experts warn
There are several strains of dermatophytes, which are usually transmitted through skin-to-skin contact. Fungal spores can live on your skin and under your nails for some time without causing a rash, and they thrive in warm, humid places like wet towels and locker room floors.
This is why athlete’s foot, a form of dermatophyte that gets lodged between the toes, is often picked up in communal showers.
The fungi can also infect the scalp, causing a form of dandruff.
Drying the affected area, for example, using talcum powder may help reduce the severity of the rash but may not cure it. Specific antifungal treatments are the only effective way to destroy dermatophytes.
The drug recommended by the NHS is terbinafine, the active ingredient in Lamisil Once and other over-the-counter treatments. But this is one of the drugs that are becoming increasingly ineffective, experts warn.
“This problem has grown over the past five years and we are now at a point where these difficult-to-treat infections are becoming commonplace,” says Professor Darius Armstrong-James, an infectious disease expert at Imperial College London. ‘Patients often need to use multiple applications of terbinafine. This is the case in about a third of cases.’
Drug-resistant infections might respond to stronger antifungal drugs or combinations of these drugs used concurrently and for long periods. However, these treatments sometimes cause unpleasant side effects including intestinal problems and nausea.
Professor Armstrong-James classifies a “significant” number of his patients as “untreatable,” meaning they have to use antifungal drugs almost continuously to keep their infections under control.
Like bacteria, fungi, a class of organisms that includes yeasts and fungi, can evolve to develop stronger defenses against drugs designed to kill them. And overuse of antifungal medications can accelerate the development of difficult-to-treat strains.
Experts point to the massive use of antifungal pesticides in the food industry, which protect fruits and vegetables from being spoiled by fungal infections.
‘This creates the perfect conditions for the formation of drug-resistant strains of fungi,’ says Prof. Armstrong-James.
“These then make their way into animals and humans.”
Overuse of antifungal drugs is also driving the problem.
“Patients will keep going back to the pharmacy to get more terbinafine, even if it doesn’t work, or they’ll stop taking the treatment before the course is over,” says Dr. Neil McCarthy, an expert on fungal infections at Queen Mary University of London. “This allows the fungus to build up resistance.”
Experts say one possible solution is to ensure all antifungal treatments are prescribed by a doctor.
“A doctor might take a sample of the infection and test it in a lab to see if it’s already resistant to terbinafine before offering treatment,” says Dr. McCarthy.
In 2014, scientific advisers to the European Commission suggested removing antifungal treatments from cosmetic products, such as anti-dandruff shampoo, to slow the growth of the drug-resistant fungus, but this has not yet happened.
Ultimately, experts say the key is to develop new drugs.
“There are only a small number of new treatments coming for athlete’s foot,” says Prof. Armstrong-James. “If we don’t quickly focus more research into this area, we will soon be in a position where millions of Britons are experiencing very annoying, debilitating and recurring skin infections.”
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