Beautiful feet in summer: a comparison of natural and artificial antifungal treatments

Fungal infections of the skin and nails are among the most common conditions encountered in podiatry practice. Many patients are looking for a treatment that is quick, effective and, at the same time, gentle on the body. However, given the wide range of products available – from natural-based preparations to artificial medicines – the choice is not always an easy one.

How do natural and artificial antifungals actually differ? And what role do they play in the treatment of skin and nail fungal infections? A look at the key active ingredients and their properties helps to clarify their use in practice.

Essential oils have been used for centuries to support skin health. With these complex mixtures of volatile plant compounds, the main constituents of which are usually so-called terpenes, the compounds possess pronounced antimicrobial properties and can attack fungi on several levels: they damage the cell membrane, disrupt important metabolic processes and inhibit vital enzymes. 

Among the best-known essential oils with antifungal properties are:

• Citrus oils such as lemon, orange or lime. They contain high levels of the terpene limonene, which possesses both antibacterial and antifungal properties.
• Tea tree and thyme oils contain the active ingredients thymol and carvacrol. These are especially effective against bacteria, viruses and fungi. Carvacrol, in particular, is often described as one of the strongest natural antifungals.
• Rosemary oil along with the oils of pine, spruce or fir contain pinene, which also has antimicrobial properties.

However, whether an essential oil can exert its full effect depends not only on the plant species, but also on how it was produced.

Not all essential oils are the same – depending on the production method, the spectrum of active ingredients and the quality can vary considerably. It is therefore worth taking a look at the product information for podiatry practices, as only unrefined or natural oils provide the full spectrum of active ingredients relevant to an antifungal effect:

Unprocessed oils are extracted directly from plants and contain the full natural spectrum of active ingredients.

Natural oils are made up of several naturally pure components of different origins. They contain no artificial additives. ‘Naturally pure’ refers to a single, unadulterated raw material – in contrast to ‘natural’, which describes a formulation of several naturally pure components.

Nature-identical oils are produced artificially and are modelled on natural counterparts in terms of scent and composition. However, they are usually significantly less complex. Whilst natural rosemary oil, for example, can contain around 150 constituents, the nature-identical variant is made with only about eleven components.

As important as essential oils may be, they are not without risks. Many oils can irritate the skin and should therefore only be used in diluted form, for example when used in combination with vegetable oils or as an ingredient in specialised skincare products. Furthermore, allergies or intolerances may occur. Especially in the case of pre-existing or sensitive skin conditions, such as diabetic foot or inflammatory skin lesions, particular caution is advised.

A special case is bisabolol, the main active ingredient in chamomile oil. Although it possesses lightweight to moderate antifungal properties, it is primarily known for its anti-inflammatory and skin-soothing effects. In cases of acute fungal infections, its antifungal effect alone is usually inadequate, but it can provide practical support for skin care.

Whilst essential oils have been used primarily in the beauty and skincare sectors, artificial antifungals have for many years formed an important pillar of treatment for fungal infections and have a well-documented spectrum of activity.

A commonly used active ingredient in beauty products to maintain the health of skin and nails prone to fungal infections is piroctone olamine. This artificial compound is found in many nail tinctures, sprays and varnishes for treating nail fungus. The active ingredient penetrates the cell membrane of dermatophytes and yeasts, disrupts their energy metabolism and ultimately leads to the death of the pathogens.

It is interesting to note that the effectiveness of piroctone olamine depends on the pH value. The substance exhibits its optimum antifungal effect in the slightly acidic to neutral range between pH 6 and 7. At higher pH levels, the effect decreases significantly. This is relevant in practice, as different skincare products can also influence the skin’s pH level. When combining products, it is therefore worth checking the pH levels of the preparations used.

Various groups of medical antifungal agents are available for the targeted treatment of skin and nail fungal infections:

• Azoles such as bifonazole, clotrimazole or ketoconazole
• Allylamines such as terbinafine
• Morpholines such as amorolfine
• Pyridines such as ciclopirox

These active substances specifically interfere with the fungi’s metabolism. Some inhibit the formation of ergosterol, a vital component of the fungal cell membrane. Different agents block key metabolic enzymes, then preventing the pathogens from multiplying. Their description includes dermatophytes, yeasts and moulds, which is why they are also referred to as broad-spectrum antifungals.

Many topical preparations can be received over the counter at pharmacies. They are offered in various dosage forms, including creams, balms, tinctures and medicated nail polishes, and can then be flexibly adapted to the individual clinical presentation.

The treatment of fungal infections of the skin and nails requires, besides the selection of a suitable active ingredient, patience and consistency. Equally crucial is expert guidance from qualified podiatrists, who can assess and adapt the course of treatment on an individual basis. Herbal and artificial active ingredients are not mutually exclusive; in practice, they can be usefully combined.

For patients who emphasise natural ingredients, care products containing essential oils can be a practical addition to their daily foot and nail care routine. Products from the peclavus PODOmed range combine selected plant-based ingredients with proven antimicrobial active ingredients such as piroctone olamine or bisabolol.

In the case of more severe or persistent fungal infections, it can be practical to switch to a more potent, doctor-prescribed antifungal treatment. In such cases, it is recommended to consult a doctor or pharmacist.

Ultimately, the combination of sound advice, targeted podiatric treatment and consistent adherence to the chosen products forms the basis for successful treatment. Then only can a lasting improvement be achieved and the risk of a relapse be minimised.

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Find out more about this topic in our article:  ‘Treating and preventing nail fungal infections effectively’.