From the Research
The treatment for moccasin tinea pedis typically requires oral antifungal medications due to its chronic, hyperkeratotic nature, with terbinafine 250mg daily for 2-4 weeks being the first-line treatment, as it achieves high concentrations in the stratum corneum and has fungicidal activity against dermatophytes 1.
Treatment Options
- Oral antifungal medications are the primary treatment for moccasin tinea pedis, with terbinafine being the most effective option, as shown in a study where 86% of patients who received terbinafine were mycologically negative after 8 weeks 1.
- Alternatives to terbinafine include itraconazole 200mg daily for 2-4 weeks or fluconazole 150mg weekly for 4-6 weeks.
- Topical antifungals like terbinafine 1% cream, clotrimazole 1%, or ciclopirox 0.77% applied twice daily for 4-6 weeks can be used as adjunctive therapy or for milder cases, though they're often insufficient alone for moccasin-type infections.
Adjunctive Therapy
- Keratolytic agents containing urea or salicylic acid can help reduce hyperkeratosis and improve penetration of antifungal medications, as seen in a study where the combination of bifonazole and urea ointment showed superior results compared to bifonazole alone 2.
- Patients should keep feet dry, wear breathable footwear, change socks daily, and treat all footwear with antifungal powder to prevent recurrence.
Treatment Duration
- Treatment should continue until clinical resolution is achieved, as premature discontinuation often leads to relapse due to the persistence of fungi in the thickened stratum corneum of the foot.
- A study showed that terbinafine treatment for 2 weeks was effective in achieving mycological cure in 86% of patients, with continued resolution at follow-up evaluations 1.