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

Abstract

Background: Tinea pedis is a type of dermatophytosis that affects the superficial layers of the skin on feet. Limited data are available on the skin microbiome composition in affected patients and its changes following topical antifungal therapy.

Objectives: To evaluate the clinical and microbiological effects of topical ketoconazole 2% cream (KTZ) and miconazole nitrate 2% cream (MCZ) using standardised clinical scoring and amplicon sequencing.

Methods: A total of 42 patients with tinea pedis and 28 healthy controls were enrolled. Skin swabs were collected from lesional sites (interdigital or heel) at baseline, after 4 weeks of treatment, and 2 weeks post-treatment. DNA was extracted from the samples, and the bacterial 16S rRNA (V3-V4 region) and fungal ITS1-5F regions were sequenced to analyse microbial community composition.

Results: Both KTZ and MCZ led to comparable clinical improvement. However, the KTZ group showed faster symptom resolution and a higher sustained improvement rate during follow-up. Treatment with either antifungal effectively reduced the abundance of pathogenic Trichophyton species to levels similar to those in healthy controls, thereby contributing to partial recovery of the overall fungal community structure. In parallel, the bacterial profile became more dispersed, with notable shifts observed in bacterial genera such as Staphylococcus and Corynebacterium following treatment.

Conclusion: Topical antifungal therapy with KTZ or MCZ effectively improved the symptoms of tinea pedis, diminished the pathogenic fungal load and altered both fungal and bacterial community compositions. However, only partial restoration of the mycobiome was achieved, and the bacterial profile, especially in the interdigital region, showed a lack of bacterial normalisation. These findings highlight the need for further studies to assess long-term outcomes and to explore microbiome-targeted strategies addressing both bacterial and fungal components.