Managing Tinea Pedis: Griseofulvin and Gentamicin Cream Treatment Guide

Oral Griseofulvin (250 mg) and topical Gentamicin cream?

Hello, Dr.
Wu.
I have hyperhidrosis, and my hands and feet sweat excessively.
Last summer, I developed a rash on the top of my right foot due to wearing shoes in the heat (it was very itchy).
Initially, it was only on my right foot, but then it spread to my left foot.
Eventually, the rash covered the entire top of my left foot, causing peeling and intense itching.
The right foot healed, but the left foot did not improve (it has small red rashes, red patches, and raised bumps resembling papules, and the affected areas have peeled and turned dark).
It has also spread to my ankle, and I developed blisters on the top of my left foot that were painful enough to prevent me from walking.
I consulted a dermatologist, who said I was using the wrong medication (because I had applied an eczema cream from home during severe episodes).
The doctor diagnosed it as tinea pedis (athlete's foot) and advised me to follow a treatment plan for 5 to 6 weeks, which includes taking Griseofulvin (250 mg) orally (two capsules after breakfast and dinner) and applying Gentamicin cream topically.
I researched the medication online and found that it can harm the liver and kidneys and has photosensitivity side effects, making long-term use inadvisable.
If used long-term, liver, kidney, and hematologic functions need to be monitored.
When I asked the doctor if it would harm my liver and if I should check my liver function first, he said that while Griseofulvin can affect the liver, it is not as harmful as another medication he did not prescribe.
Dr.
Wu, is taking Griseofulvin for 5 to 6 weeks considered long-term medication? Should I have blood tests to monitor liver and kidney function during the treatment? If there are photosensitivity side effects, can I still engage in outdoor activities? Besides avoiding alcohol and spicy foods, are there any other dietary restrictions I should follow? Thank you very much, doctor!

Xiao Xing Xing, 20~29 year old female. Ask Date: 2016/03/14

Dr. Wu Yuxin reply Dermatology

No need for blood tests unless you experience discomfort during the medication period; you should stop the medication and consult your attending physician.
There are photosensitivity side effects, so it is recommended to reduce outdoor activities.
There are no specific dietary restrictions.

Reply Date: 2016/03/14

More Info

Managing Tinea Pedis, commonly known as athlete's foot, can be a challenging process, especially when dealing with symptoms like itching, redness, and peeling skin. In your case, the prescribed treatment involves oral Griseofulvin and topical Gentamicin cream. Let's break down the treatment, its risks, and considerations for your specific situation.

Griseofulvin Overview
Griseofulvin is an antifungal medication used to treat various fungal infections, including Tinea Pedis. It works by inhibiting fungal cell division, thereby stopping the spread of the infection. The typical dosage you mentioned (250 mg taken twice daily after meals) is standard for treating such infections.

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Risks and Considerations
1. Liver and Kidney Function: Griseofulvin can have hepatotoxic effects, although the risk is relatively low with short-term use. Since your treatment duration is 5-6 weeks, this is not considered long-term therapy. However, monitoring liver function is prudent, especially if you have pre-existing liver conditions or if you experience symptoms like jaundice, dark urine, or persistent nausea.

2. Blood Tests: Routine blood tests to monitor liver and kidney function are not typically required unless you experience adverse effects. If you feel unwell or notice any unusual symptoms, it’s essential to consult your healthcare provider.

3. Photosensitivity: Griseofulvin can cause photosensitivity, meaning your skin may become more sensitive to sunlight. It is advisable to limit sun exposure and wear protective clothing or sunscreen if you plan to be outdoors. If you experience significant discomfort or skin reactions, consider reducing outdoor activities during peak sunlight hours.

4. Dietary Restrictions: While there are no strict dietary restrictions with Griseofulvin, it is wise to avoid alcohol, as it can increase the risk of liver damage. Spicy foods are not contraindicated but may cause discomfort in some individuals, so listen to your body.

Gentamicin Cream Overview
Gentamicin is an antibiotic that is effective against certain bacterial infections. In your case, it may be used to prevent secondary bacterial infections in areas affected by Tinea Pedis.

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Risks and Considerations
1. Topical Use: Gentamicin cream is generally safe for topical use, but prolonged use can lead to local irritation or allergic reactions. Monitor the application site for any signs of worsening redness, swelling, or rash.

2. Ear Toxicity: While you mentioned concerns about ear toxicity, the risk of systemic absorption leading to hearing loss is minimal with topical application. However, if you experience symptoms like tinnitus (ear ringing) or hearing changes, consult your doctor immediately.

3. Duration of Use: The duration of using Gentamicin cream typically depends on the resolution of symptoms. It is advisable to continue using it until the infection is cleared, which may take a few days to weeks. If the condition does not improve or worsens, follow up with your healthcare provider.

Conclusion
In summary, your treatment plan with Griseofulvin and Gentamicin cream is appropriate for managing Tinea Pedis. While there are risks associated with both medications, the short duration of treatment and your doctor's reassurance regarding liver safety suggest that you can proceed with the therapy. Keep an eye on your symptoms, maintain communication with your healthcare provider, and adjust your activities as needed to ensure a smooth recovery. If you have any further concerns or experience any adverse effects, do not hesitate to reach out to your healthcare professional for guidance.

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