Treatment of fungal infection accelerate diabetic foot ulcer healing

Admin2 · Jan 20, 2012

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Targeted treatment of invasive fungal infections accelerates healing of foot wounds in patients with Type2 diabetes.
Chellan G, Neethu K, Varma AK, Mangalanandan TS, Shashikala S, Dinesh KR, Sundaram KR, Varma N, Jayakumar RV, Bal A, Kumar H.
Diabet Med. 2012 Jan 16

Aim: To test the hypothesis that fluconazole plus standard care is superior to the standard care for diabetic foot wounds infected with deep-seated fungal infections.

Methods: We carried out a randomized, controlled, open-label, parallel-arm study in 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds. Thirty-seven patients (control group) were given standard care (surgical debridement + culture-specific antibiotics + offloading + glycaemic control) and 38 patients (treatment group) were given fluconazole 150 mg daily plus standard care. Wound surface area was measured every 2 weeks until the endpoints (complete epithelialization or skin grafting) were met.

Results: By week 4, the mean wound surface area reduced to 27.3 from 111.5 cm(2) in the treatment group, as opposed to 67.1 from 87.3 cm(2) in the control group. Subsequently, the mean wound surface areas were remarkably smaller in the treatment group compared with the control group, and statistically significant differences (P ≤ 0.05) in mean wound surface area were observed between the treatment group and the control group at week 6. However, no statistically significant (P = 0.47) difference in complete healing was observed between the treatment group and the control group, 20 vs. 24. The mean wound healing time for the treatment group was 7.3 weeks, whereas for the control group it was 11.3 weeks (P = 0.022). Similarly, the probability of wound healing in the treatment group was 50 vs. 20% in the control group at week 10.

Conclusions: Fluconazole plus standard care was superior to standard care alone in accelerating wound reduction among patients with diabetes with deep-seated fungal infections in diabetic foot wounds. Those in the treatment group who did heal, healed more quickly (P = 0.022), but overall healing was not different
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Admin2 · Jan 20, 2012

Related Thread:
Topical nail antifungal and risk for diabetic foot ulceration

NewsBot · Mar 21, 2015

Association between Washing Residue on the Feet and Tinea Pedis in Diabetic Patients.
Takehara K et al
Nurs Res Pract. 2015;2015:872678.

Tinea pedis (TP) may lead to the development of foot ulcers in diabetic patients; thus, its prevention in diabetic patients is important. TP occurs after dermatophytes on the skin scales of TP patients attach to the feet. Therefore, it is necessary to remove the scales and dermatophytes, and this can be performed using various methods, including foot washing. This study aimed to objectively examine the association between the presence of TP and foot-washing habits. We included 33 diabetic patients, and, of these, 17 had TP. The presence of washing residue on the feet was determined by applying a fluorescent cream to the participants' feet, and images of the feet were captured under ultraviolet light before and after foot washing. Our results showed that diabetic patients with TP had higher levels of washing residue on their feet than those without TP. The importance of washing feet to prevent TP needs to be emphasized through educational programs for diabetic patients. Furthermore, the development of an effective foot-washing technique is essential.
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zsuzsanna · Mar 21, 2015

I have seen several patients with onychomychosis and TP with long standing ulcers which refuse to heal and I am convinced that there is a connection between them especially in diabetic patients. But how can I impress on their GP to treat the OM and TP in order to heal the ulcer?
When the wound is dressed once or if they are lucky twice a week, there is very little time to wash the feet or legs properly.

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