Clioquinol 3% Cream Improves Clinical Symptoms and Restores the Skin Microbiome in Interdigital Tinea Pedis

Abstract

Background: Interdigital tinea pedis is a common type of tinea pedis that occurs between toes and is easy to recur. Recently, the skin microbiome analysis of interdigital tinea pedis showed changes in bacterial microbiome in addition to fungal infection.

Objectives: To investigate the efficacy and safety of clioquinol 3% cream in treating interdigital tinea pedis as well as characterize changes in the skin microbiome during treatment.

Methods: The clinical characteristics and skin microbiome of patients with interdigital tinea pedis were investigated in a longitudinal prospective study. In total 28 participants were rcruited to use the clioquinol 3% cream topically to the target skin lesions twice a day for 1 week. Disease severity evaluation, fungal microscopic examination, and sample collection for skin microbiome analysis were performed at baseline, after treatment, and 1 week post-treatment.

Results: Compared with baseline, the disease severity, lesion score, pruritus score, and malodor score of the patients significantly decreased after treatment and at 1 week post-treatment (P < 0.05). The fungal profiles after treatment and 1 week post-treatment revealed significantly decreased abundance of Trichophyton and significantly increased abundances of Cladosporium, Alternaria, and Aspergillus, which led to higher fungal diversity than pretreatment samples. The bacterial profiles after treatment and 1 week post-treatment revealed significantly decreased abundances of Brevibacterium, Finegoldia, and Facklamia. The abundance of Streptococcus and bacterial diversity were also significantly decreased at 1 week post-treatment. The disease severity was positively associated with the abundance of Trichophyton, Arthroderma, Finegoldia, Facklamia, Brevibacterium, Corynebacterium, and Porphyromonas.

Conclusions: The clioquinol 3% cream was efficient on treating interdigital tinea pedis by decreasing the abundance of pathogenic fungus, recovering the normal balance of the fungal and bacterial communities, and restore species diversity.

Keywords: Clioquinol; Efficacy; Interdigital tinea pedis; Microbiome; Safety.