From the Guidelines
The first-line treatment for tinea pedis is ciclopirox olamine cream or gel (0.77%) applied twice daily to the affected areas for 4 weeks, as it has been shown to be effective in eradicating the infection and superior to other treatments. This recommendation is based on a randomized controlled trial in adults, which demonstrated the efficacy of ciclopirox olamine in achieving both clinical and mycological cure 1. The treatment should be applied to clean and dry affected areas, and it is essential to continue the treatment for the full recommended duration, even if symptoms improve earlier, to prevent recurrence. Some key points to consider when treating tinea pedis include:
- Cleaning and drying the affected area before applying the medication
- Spreading a thin layer of the medication over the infected skin and slightly beyond its borders
- Continuing treatment for the full recommended duration
- Keeping feet dry, wearing breathable footwear, and changing socks daily to prevent recurrence
- Avoiding walking barefoot in public areas like pools and showers to prevent the spread of the infection. The mechanism of action of ciclopirox olamine involves disrupting the fungal cell membrane, which is essential for fungal cell survival 1. Overall, ciclopirox olamine cream or gel (0.77%) is a highly effective treatment for tinea pedis, and its use as a first-line treatment can help to improve outcomes and reduce the risk of recurrence 1.
From the FDA Drug Label
Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor. Directions clean the affected area and dry thoroughly apply a thin layer of the product over affected area twice daily (morning and night) or as directed by a doctor The first line treatment for tinea pedis (athlete's foot) is terbinafine (TOP) or miconazole (TOP).
- For terbinafine (TOP): apply twice a day for 1 week between the toes or 2 weeks on the bottom or sides of the foot 2.
- For miconazole (TOP): apply a thin layer twice daily for 4 weeks 3.
From the Research
First Line Treatment for Tinea Pedis
- The first line treatment for tinea pedis typically involves topical antifungal therapy 4, 5.
- Topical antifungal agents such as allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine are commonly used 5.
- Treatment duration for tinea pedis is usually four weeks with an azole or one to two weeks with allylamine medication 4.
- Studies have shown that terbinafine is an effective treatment for tinea pedis, with mycological cure rates ranging from 71% to 97% 6, 7, 8.
- Terbinafine has been compared to clotrimazole in several studies, with results showing that terbinafine achieves mycological cure more rapidly and has higher cure rates 6, 7, 8.
Treatment Options
- Topical terbinafine 1% cream applied twice daily for one week has been shown to be effective in treating tinea pedis 6, 7, 8.
- Clotrimazole 1% cream applied twice daily for four weeks is also a treatment option, although it may have lower cure rates compared to terbinafine 6, 7, 8.
- Oral antifungal therapy, such as terbinafine, itraconazole, and fluconazole, may be reserved for severe disease, failed topical antifungal therapy, or in immunocompromised patients 5.