Management of Interdigital Maceration of Toe Web Spaces Using an Antimicrobial Absorptive Dressing

Introduction:  Interdigital maceration of toe web spaces, a clinical indication of infection, is a contributing factor to lower extremity cellulitis.¹In addition to fungal involvement, greater than 60% of the microbiological flora associated with these infections are related to Staphylococcus Aureus and Pseudomonal species.^2,3 Common treatment practice includes oral antibiotics and topical anti-fungal agents in conjunction with the placement of gauze or lamb’s wool interdigitally.¹ The literature does not report the use of a topical antimicrobial absorptive dressing as clinical management option in this population.

Objective:Case series evaluation of a Sodium Carboxymethylcellulose Dressing with Ionic Silver (Na-CMC-Ag) ribbon dressing with strengthening fibers*effect on outcomes in patients with interdigital maceration.

Method: A Na-CMC-Ag dressing ribbon dressing with strengthening fibers was placed onto the toe web spaces of a convienience sample of five patients with interdigital maceration and changed weekly until resolved with weekly follow-up for recurrence for one month. Patients or significant others who were applying the dressing were queried on ease of application.

Outcome: All patients had resolution of interdigital maceration within 2 weeks. No oral antibiotics or topical antifungal agents were used. No recurrences of interdigital maceration recurred within 30 days. All patients reported ease in application and removal. No residual dressing remained interdigitally after removal.

Conclusions: The use of a Na-CMC-Ag dressing with strengthening fibers may be a viable method to resolve interdigital maceration and may help avoid use of costly oral antibiotics and topical antifungals. In these cases, weekly application seemed to promote patient compliance. Further studies are warranted in larger populations.

*AQUACEL® Ag with Ribbon Dressing Strengthening Fibers

AQUACEL is a registered trademark of ConvaTec,  Inc., Skillman, NJ