From the Guidelines
Tinea pedis can be effectively treated with ciclopirox olamine 0.77% cream or gel applied twice daily to the affected areas for 4 weeks, as it has been shown to be superior to other treatments in achieving both clinical and mycological cure. This treatment has been evaluated in randomized controlled trials in adults and has proven efficacy against T rubrum, T mentagrophytes, and Epidermophyton floccosum 1.
Key Points to Consider
- Obesity and diabetes are additional risk factors for T pedis, and patients with these conditions should be closely monitored and treated promptly to prevent complications 1.
- Topical antifungals like ciclopirox olamine cream or gel should be applied twice daily to the affected areas for 4 weeks, and treatment should continue for at least one week after symptoms resolve.
- Keeping feet clean and dry, wearing breathable footwear, changing socks daily, and avoiding walking barefoot in public areas can help prevent reinfection.
- Symptoms should improve within a few days of starting treatment, but completing the full course is essential to prevent recurrence.
Treatment Options
- Ciclopirox olamine 0.77% cream or gel applied twice daily for 4 weeks
- Other topical antifungals like clotrimazole 1% or terbinafine 1% cream or powder may also be effective, but ciclopirox olamine has been shown to be superior in achieving clinical and mycological cure 1.
- For severe or resistant cases, prescription-strength medications like oral terbinafine or itraconazole may be necessary, but these should be used under the guidance of a healthcare professional.
From the FDA Drug Label
Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions
Representative treatment periods are ... tinea pedis, 4 to 8 weeks;
- Terbinafine (TOP) is used to cure most athlete's foot (tinea pedis) and relieve accompanying symptoms such as itching, burning, cracking, and scaling 2.
- Griseofulvin (PO) treatment for tinea pedis typically lasts 4 to 8 weeks and may require concomitant use of topical agents 3.
- The dosage of Griseofulvin for adults is 0.5 g daily, and for pediatric patients (older than 2 years), it is 10 mg/kg daily 3.
From the Research
Treatment Options for Tinea Pedis
- Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, with examples of topical antifungal agents including allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 4
- Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients 4
- Combined therapy with topical and oral antifungals may increase the cure rate 4
Comparison of Treatment Regimens
- A study comparing oral terbinafine 250 mg once daily for 1 week with 1% clotrimazole cream applied twice daily for 4 weeks found similar mycological cure rates (71% for clotrimazole and 72% for terbinafine) 5
- Another study found that a 7-day intermittent course of oral terbinafine 250 mg/day was effective in treating plantar and interdigital tinea pedis, with cure rates of 98.5% and 93.5%, respectively 6
- A comparison of terbinafine 1% cream and clotrimazole 1% cream found that terbinafine was more effective in treating tinea pedis, with mycological cure rates of 93.5% and 73.1%, respectively, at week 4 7