Randomized controlled trial and cost-effectiveness analysis: Comparing chlorhexidine scrub, ZnO-nanoparticle socks, and their combination in pitted keratolysis treatment

A cost-effective treatment for pitted keratolysis (PK) is the use of 4% chlorhexidine scrub. Zinc oxide nanoparticle (ZnO- NP)-coated socks have also shown efficacy in PK prevention. In this study, we aimed to assess the cost-effectiveness and safety of combined 4% chlorhexidine scrub and ZnO- NP-coated sock treatment compared to monotherapy. This randomized, controlled trial included 60 male security guards and hospital porters aged =18 with PK. Participants were randomly assigned to one of three treatment groups: 4% chlorhexidine scrub, ZnO- NP-coated socks, or combination therapy. Treatment outcomes were evaluated after 4 weeks. Incremental cost-effectiveness ratios (ICERs) were calculated using cost-utility analysis. The greatest reduction in visual analog scale scores for foot odor was observed in the combination therapy group, but it was nonsignificant (P = 0.186). Clinical improvement was observed across all groups. The cost-utility analysis revealed that chlorhexidine scrub and regular socks were the least expensive options. The placebo and ZnO- NP-coated sock group had an ICER of US $31 082/quality-adjusted life years (QALYs) gain, while the combination therapy gained US $45 105/QALYs com- pared to the chlorhexidine scrub and regular sock group. Based on our findings, for the treatment of PK, 4% chlorhexidine scrub remains the most cost-effective choice.