Tinea pedis and onychomycosis: Practical prevention and recurrence minimization

According to epidemiological data, superficial mycoses may affect approximately 20–25% of the global population. They account for 37–40% of all dermatological diseases, which further underscores the need for discussion and development of preventive strategies both within the specialty and in an interdisciplinary context. The imperative to update approaches to timely prophylaxis and appropriately prescribed antifungal therapy is driven by the rising incidence of complications associated with long-standing dermatophytoses, as well as by recurrent mycotic infections in high-risk populations. The article analyzes 34 publications devoted to the treatment of mycoses of the feet and onychomycosis, posted on the websites of specialized foreign and Russian scientific publications. This article reviews contemporary risk factors for tinea pedis and onychomycosis, including a dynamic lifestyle, self-medication, hereditary predisposition, and comorbid conditions. Preventive measures are examined, the observance of which is critical not only for achieving optimal outcomes of antimycotic treatment but also for preventing disease recurrence. Topical agents are systematically categorized, with their potential utility as adjuncts in combination therapy for mycoses and as prophylactic tools for modifying risk factors for tinea pedis and onychomycosis. The successful management of mycosis depends not only on accurate diagnosis but also on patient adherence to prolonged treatment regimens and preventive measures, as well as on the recognition that relapses are common and are likely to necessitate further therapy. At present, robust evidence is lacking to support a long-term maintenance regimen of topical etiotropic therapy as a strategy for preventing or reducing the frequency of recurrences. Nevertheless, a number of straightforward preventive principles have been identified, which patients may adopt to improve their clinical status, achieve remission, and, over the long term, prevent the recurrence of mycosis.

1. Ghannoum M, Isham N. Fungal nail infections (onychomycosis): a neverending story? PLoS Pathog. 2014;10(6):e1004105. https://doi.org/10.1371/journal.ppat.1004105.

2. Cisoń H, Kostrzewska P, Łątka N, Krajewski PK, Szepietowski J, Konsur-Jankowska A et al. Awareness of people using municipal swimming pools about the prevention, symptoms, and treatment of athlete’s foot and onychomycosis before COVID-19. Postepy Dermatol Alergol. 2024;41(2):226–231. https://doi.org/10.5114/ada.2024.136083.

3. Deng R, Wang X, Li R. Dermatophyte infection: from fungal pathogenicity to host immune responses. Front Immunol. 2023;14:1285887. https://doi.org/10.3389/fimmu.2023.1285887.

4. Tosti A, Elewski BE. Onychomycosis: Practical Approaches to Minimize Relapse and Recurrence. Skin Appendage Disord. 2016;2(1-2):83–87. https://doi.org/10.1159/000448056.

5. Matricciani L, Talbot K, Jones S. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review. J Foot Ankle Res. 2011;4:26. https://doi.org/10.1186/1757-1146-4-26.

6. Son JH, Doh JY, Han K, Kim YH, Han JH, Bang CH et al. Risk factors of dermatophytosis among Korean adults. Sci Rep. 2022;12:13444. https://doi.org/10.1038/s41598-022-17744-5.

7. Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol. 2009;61(2):242–246. https://doi.org/10.1016/j.jaad.2009.02.038.

8. Sergeev AY, Sergeev YV. Host Resistance and Immunity in Superficial Fungal Infections. Immunopathology, Allergology, Infectology. 2004;(1):6–14. (In Russ.) Available at: https://www.elibrary.ru/rvmdgp.

9. Gold JAW, Wu K, Jackson BR, Benedict K. Opportunities to improve guideline adherence for the diagnosis and treatment of onychomycosis: Analysis of commercial insurance claims data, United States. J Am Acad Dermatol. 2023;88(3):683–686. https://doi.org/10.1016/j.jaad.2022.06.1201.

10. Ko JY, Lee HE, Jae H, Oh DH, Kim JS, Yu HJ. Cure rate, duration required for complete cure and recurrence rate of onychomycosis according to clinical factors in Korean patients. Mycoses. 2011;54(5):e384–e388. https://doi.org/10.1111/j.1439-0507.2010.01928.x.

11. Wu CY, Chen GS, Lan CC. Onychomycosis caused by Fusarium solani in a woman with diabetes. Clin Exp Dermatol. 2009;34(8):e772–e774. https://doi.org/10.1111/j.1365-2230.2009.03498.x.

12. Arenas R, Bonifaz A, Padilla MC, Arce M, Atoche C, Barba J et al. Onychomycosis. A Mexican survey. Eur J Dermatol. 2010;20(5):611–614. Available at: https://www.jle.com/10.1684/ejd.2010.1023.

13. Silina LV. Algorithms for topical therapy of mycoses at the daily appointment of a dermatologist. Meditsinskiy Sovet. 2024;18(14):7–12. (In Russ.) https://doi.org/10.21518/ms2024-284.

14. Ray A, Das A, Panda S. Antifungal stewardship: What we need to know. Indian J Dermatol Venereol Leprol. 2023;89(1):5–11. https://doi.org/10.25259/IJDVL_91_2022.

15. Mayorov RYu, Surkichin SI. Podology issues: Optimization of onychomycosis therapy. Medical Alphabet. 2023;(24):16–19. (In Russ.) https://doi.org/10.33667/2078-5631-2023-24-16-19.

16. Petrova SYu, Albanova VI, Guzev KS. Hyperhidrosis: problems and solutions. Vestnik Dermatologii i Venerologii. 2024;100(1):73–84. (In Russ.) https://doi.org/10.25208/vdv11878.

17. Takehara K, Oe M, Tsunemi Y, Nagase T, Ohashi Y, Iizaka S et al. Factors associated with presence and severity of toenail onychomycosis in patients with diabetes: a cross-sectional study. Int J Nurs Stud. 2011;48(9):1101–1108. https://doi.org/10.1016/j.ijnurstu.2011.02.005.

18. Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, Wong AHC. Onychomycosis: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(1):32–45. https://doi.org/10.2174/1872213X13666191026090713.

19. Farag AGA, Hammam MA, Ibrahem RA, Mahfouz RZ, Elnaidany NF, Qutubuddin M, Tolba RRE. Epidemiology of dermatophyte infections among school children in Menoufia Governorate, Egypt. Mycoses. 2018;61(5):321–325. https://doi.org/10.1111/myc.12743.

20. Gupta AK, Liddy A, Magal L, Shemer A, Cooper EA, Saunte DML, Wang T. Onychomycosis in Diabetics: A Common Infection with Potentially Serious Complications. Life. 2025;15(8):1285. https://doi.org/10.3390/life15081285.

21. Amichai B, Grunwald MH, Davidovici B, Farhi R, Shemer A. The effect of domestic laundry processes on fungal contamination of socks. Int J Dermatol. 2013;52(11):1392–1394. https://doi.org/10.1111/ijd.12167.

22. Lipner SR, Scher RK. Management of onychomycosis and co-existing tinea pedis. J Drugs Dermatol. 2015;14(5):492–494. Available at: https://jddonline.com/articles/management-of-onychomycosis-and-coexisting-tinea-pedis-S1545961615P0492X/.

23. Hammer TR, Mucha H, Hoefer D. Infection risk by dermatophytes during storage and after domestic laundry and their temperature-dependent inactivation. Mycopathologia. 2011;171(1):43–49. https://doi.org/10.1007/s11046-010-9347-9.

24. Akhoundi M, Nasrallah J, Marteau A, Chebbah D, Izri A, Brun S. Effect of Household Laundering, Heat Drying, and Freezing on the Survival of Dermatophyte Conidia. J Fungi. 2022;8(5):546. https://doi.org/10.3390/jof8050546.

25. Abney SE, Ijaz MK, McKinney J, Gerba CP. Laundry Hygiene and Odor Control: State of the Science. Appl Environ Microbiol. 2021;87(14):e0300220. https://doi.org/10.1128/AEM.03002-20.

26. Gupta AK, Ahmad I, Summerbell RC. Comparative efficacies of commonly used disinfectants and antifungal pharmaceutical spray preparations against dermatophytic fungi. Med Mycol. 2001;39(4):321–328. https://doi.org/10.1080/mmy.39.4.321.328.

27. Skaastrup KN, Astvad KMT, Arendrup MC, Jemec GBE, Saunte DML. Disinfection trials with terbinafine-susceptible and terbinafine-resistant dermatophytes. Mycoses. 2022;65(7):741–746. https://doi.org/10.1111/myc.13468.

28. Ghannoum MA, Isham N, Long L. Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc. 2012;102(4):309–313. https://doi.org/10.7547/1020309.

29. Gupta AK, Brintnell W. Ozone gas effectively kills laboratory strains of Trichophyton rubrum and Trichophyton mentagrophytes using an in vitro test system. J Dermatolog Treat. 2014;25(3):251–255. https://doi.org/10.3109/09546634.2012.714456.

30. Feuilhade de Chauvin M. A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%. J Eur Acad Dermatol Venereol. 2012;26(7):875–878. https://doi.org/10.1111/j.1468-3083.2011.04176.x.

31. Kasikhina EI. The possibilities of treatment and prevention of relapses of superficial skin mycoses. RMJ. 2017;25(11):854–858. (In Russ.) Available at: https://www.rmj.ru/articles/dermatologiya/Vozmoghnosti_lecheniya_i_profilaktiki_recidivov_poverhnostnyh_mikozov_koghi/.

32. Navarro-Pérez D, Tardáguila-García A, García-Oreja S, Álvaro-Afonso FJ, López-Moral M, Lázaro-Martínez JL. Treatment of Onychomycosis and the Drug-Drug Interactions in Patients with Diabetes Mellitus and Diabetic Foot Syndrome: A Systematic Review. Infect Dis Rep. 2025;17(1):4. https://doi.org/10.3390/idr17010004.

33. Khaldoun K, Khizar S, Saidi-Besbes S, Zine N, Errachid A, Elaissari A. Synthesis of silver nanoparticles as an antimicrobial mediator. J Umm Al-Qura Univ Appl Sci. 2025;11:274–293. https://doi.org/10.1007/s43994-024-00159-5.

34. Klyuchareva SV, Nozdrin VI, Guzev KS, Karpova AV. Application of Formagel® drugs and Uroderm in patients with mycosis stop in combination with hyperhydrosis. Journal of Postgraduate Medical Education. 2019;(1):39–51. (In Russ.) Available at: https://retinoids.ru/pub/articles/primenenie-preparatov-formagel-i-uroderm-u-patsientov-s-mikozom-stop-v-sochetanii-s-gipergidrozom.