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The Effect of Topical Ketoconazole and Topical Miconazole Nitrate in Modulating the Skin Microbiome and Mycobiome of Patients With Tinea Pedis

Summary

This study examined how two common antifungal creams (ketoconazole and miconazole) affect the complex community of bacteria and fungi living on the skin of people with athlete’s foot. Both treatments effectively reduced the harmful fungus causing the infection and improved symptoms, with ketoconazole working slightly faster. However, the researchers found that while these treatments reduced the disease-causing fungus, the skin’s normal microbial community did not fully recover to a healthy state, particularly in the spaces between the toes.

Background

Tinea pedis is a common superficial fungal infection affecting approximately 3% of the world population. Limited data exist on how topical antifungal treatments affect the skin microbiome composition in affected patients. Understanding these microbial changes is important for improving treatment outcomes and reducing disease recurrence.

Objective

To evaluate the clinical and microbiological effects of topical ketoconazole 2% cream and miconazole nitrate 2% cream on the skin microbiome and mycobiome of tinea pedis patients using clinical scoring and amplicon sequencing.

Results

Both ketoconazole and miconazole effectively reduced Trichophyton abundance to levels similar to healthy controls and improved clinical symptoms. Ketoconazole showed faster symptom resolution and higher sustained improvement rates. Treatment altered both fungal and bacterial communities, but only partial restoration of the mycobiome was achieved, with incomplete bacterial normalization particularly in interdigital regions.

Conclusion

Topical antifungal therapy with ketoconazole or miconazole effectively improved tinea pedis symptoms and reduced pathogenic fungal load, though only partial microbiome restoration occurred. Further long-term studies with larger cohorts are needed to assess microbiome-targeted strategies addressing both bacterial and fungal components to prevent disease recurrence.
  • Published in:Mycoses,
  • Study Type:Clinical Trial,
  • Source: PMID: 40964723, DOI: 10.1111/myc.70116
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