From the Guidelines
The recommended treatment for athlete's foot typically involves over-the-counter antifungal medications such as clotrimazole (Lotrimin), miconazole (Desenex), or terbinafine (Lamisil). Apply these creams, sprays, or powders to the affected area twice daily for 1-2 weeks, continuing for at least one week after symptoms disappear to ensure complete eradication of the fungus. For more severe infections, prescription-strength medications like oral terbinafine (250mg daily for 2 weeks) or itraconazole (200mg daily for 1 week) may be necessary, as suggested by the British Association of Dermatologists' guidelines 1.
While treating athlete's foot, it is essential to keep feet clean and dry, change socks daily, wear breathable footwear, and avoid walking barefoot in public areas. These measures are important because the fungus (typically Trichophyton species) thrives in warm, moist environments between toes and on the soles of feet. The antifungal medications work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell survival, while having minimal effect on human cells.
Some key considerations to prevent recurrence include:
- Keeping nails as short as possible
- Avoiding sharing toenail clippers with family members and friends
- Applying an absorbent powder, and antifungal powders containing miconazole, clotrimazole or tolnaftate in shoes and on the feet
- Wearing cotton, absorbent socks
- Discarding old and mouldy footwear or treating them with naphthalene mothballs or a terbinafine solution, as outlined in the guidelines for the management of onychomycosis 1.
By following these treatment and prevention strategies, individuals can effectively manage athlete's foot and reduce the risk of recurrence.
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.
The recommended treatment for athlete's foot using terbinafine (TOP) antifungal is to:
- Apply the medication twice a day (morning and night)
- For 1 week if the infection is between the toes
- For 2 weeks if the infection is on the bottom or sides of the foot
- Wear well-fitting, ventilated shoes and change shoes and socks at least once daily 2
From the Research
Treatment Options for Athlete's Foot
- Topical antifungal agents are a common treatment for athlete's foot, with options including allylamines, azoles, ciclopiroxolamine, tolnaftate, butenafine, and undecanoates 3
- Oral griseofulvin may be used for more resistant cases 4
- Preventive measures include keeping the feet dry, wearing nonocclusive leather shoes or sandals, and applying talcum or antifungal powder at least twice daily 4
Effectiveness of Antifungal Agents
- Allylamines and azoles have been shown to be effective in treating athlete's foot, with allylamines curing slightly more infections than azoles 3
- Ciclopiroxolamine and butenafine may be effective for infections of the toenails, but require daily application for prolonged periods (at least 1 year) 3
- Topical antifungal agents have been shown to be more effective than placebo in treating athlete's foot, with cure rates ranging from 70-90% 3
Management and Prevention
- Suppressing bacterial growth is essential in treating symptomatic athlete's foot, and can be accomplished by exposing the feet to air or using topical antibiotics 5
- Drying the feet is a crucial element in preventing athlete's foot, and can be achieved through the use of aluminum chloride or other drying agents 5
- Regular and prophylactic use of an effective topical antifungal may help to prevent recurrence of tinea pedis and onychomycosis 6