What is the recommended treatment for athlete's foot?

Treatment of Athlete's Foot

For athlete's foot, topical terbinafine 1% cream applied twice daily for 1 week (for interdigital infections) or 2 weeks (for bottom/sides of foot) is the recommended first-line treatment due to its superior efficacy and shorter treatment duration. 1, 2

First-Line Treatment Options

Topical Treatments

• Terbinafine 1% cream:

  • Most effective with 93.5% mycological cure rate 1
  • Application schedule:
    • Between toes: Apply twice daily for 1 week 2
    • Bottom/sides of foot: Apply twice daily for 2 weeks 2
  • Fungicidal mode of action allows for shorter treatment duration 3

• Ciclopirox olamine 0.77% cream/gel:

  • Alternative first-line option
  • Apply for 4 weeks
  • ~60% clinical and mycological cure at end of treatment, increasing to 85% cure two weeks post-treatment 1

• Tolnaftate:

  • Apply twice daily (morning and night) for 4 weeks 4
  • Less effective than terbinafine but still a viable option

Treatment for Severe or Resistant Cases

For more severe or resistant infections, oral antifungal therapy may be necessary:

• Oral terbinafine 250 mg:

  • Provides faster clinical resolution than topical treatments 1
  • Consider for extensive infection or when topical treatment fails

• Oral itraconazole 100 mg:

  • Similar mycological efficacy to terbinafine
  • Slightly higher relapse rate compared to terbinafine 1

Prevention and Management

Essential Preventive Measures

• Keep feet dry, especially between toes 1
• Wear well-fitting, ventilated shoes 2
• Change shoes and socks at least once daily 2, 1
• Apply antifungal or talcum powder to feet after bathing (reduces infection rates from 8.5% to 2.1%) 1, 5
• Wear absorbent cotton socks 5
• Avoid barefoot walking in public areas like communal showers and locker rooms 5

Special Considerations

• Diabetic patients: Require more aggressive treatment and careful monitoring due to higher risk of complications and secondary bacterial infections 1
• Athletes: At higher risk due to increased exposure to conditions that promote fungal growth; benefit from preventive measures including regular application of antifungal powders 1, 5
• Family treatment: Treat all infected family members simultaneously to prevent reinfection 1

Common Pitfalls to Avoid

1. Inadequate treatment duration: Complete the full course even if symptoms improve early
2. Neglecting environmental factors: Clean footwear and treat living spaces to prevent reinfection
3. Misdiagnosis: Athlete's foot can be confused with contact dermatitis; proper diagnosis is essential for effective treatment 6
4. Ignoring preventive measures: Prevention is crucial to avoid recurrence

Clinical Forms and Diagnosis

Three main clinical forms of tinea pedis exist:

• Interdigital (most common)
• Hyperkeratotic (moccasin-type)
• Vesiculobullous (inflammatory) 7

Diagnosis should be confirmed through KOH wet-mount examination of skin scrapings from the active border of the lesion 7.