What is the treatment for athlete's foot?

Treatment for Athlete's Foot (Tinea Pedis)

Topical terbinafine 1% cream applied twice daily for 1-2 weeks is the first-line treatment for athlete's foot due to its superior efficacy and shorter treatment duration compared to other antifungal agents. 1

First-Line Treatment Options

Topical Treatments

• Terbinafine 1% cream:

  • For infections between toes: Apply twice daily (morning and night) for 1 week 2
  • For infections on bottom or sides of foot: Apply twice daily for 2 weeks 2
  • Achieves mycological cure rate of 93.5% after just 1 week 1
  • Fungicidal mode of action allows for shorter treatment duration 3

• Ciclopirox olamine 0.77% cream/gel:

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

Treatment Algorithm

1. Identify the type of tinea pedis:

   • Interdigital (between toes): Most common presentation
   • Hyperkeratotic (moccasin-type): Affects soles, heels, and sides
   • Vesiculobullous (inflammatory): More severe form

2. Start with topical therapy:

   • Use terbinafine 1% cream as first choice 1
   • Apply after washing and thoroughly drying affected area 2

3. Monitor for response:

   • If improvement seen but mycology still positive, continue current therapy for 2-4 more weeks 1
   • If no clinical improvement, switch to second-line therapy 1

4. Second-line options (for treatment failures or severe cases):

   • Oral terbinafine 250 mg daily 1, 4
   • Oral itraconazole 100 mg daily for 4 weeks 1

Special Considerations

• Diabetic patients: Require more aggressive treatment and careful monitoring due to higher risk of complications and secondary bacterial infections 1

• Immunocompromised patients: May need longer treatment courses and closer monitoring 1

• Athletes: Benefit from additional preventive measures including regular application of antifungal powders to shoes and feet 1

Prevention of Recurrence

• Wear well-fitting, ventilated shoes 2
• Change shoes and socks at least once daily 2
• Apply foot powder after bathing (reduces infection rates from 8.5% to 2.1%) 1
• Thoroughly dry between toes 1
• Periodically clean footwear 1
• Treat all infected family members simultaneously 1

Common Pitfalls

1. Inadequate diagnosis: Clinical diagnosis alone has low accuracy; consider KOH wet-mount examination of skin scrapings from active border for confirmation 5

2. Insufficient treatment duration: Stopping treatment prematurely can lead to recurrence 1

3. Neglecting environmental factors: Failing to address contaminated footwear and household surfaces 1

4. Missing concomitant onychomycosis: Infected toenails can serve as a reservoir for reinfection 5

5. Overlooking secondary bacterial infections: Especially important in diabetic patients 1

Topical antifungal therapy has consistently demonstrated superior efficacy compared to placebo, with allylamines (like terbinafine) showing slightly better outcomes than azoles for athlete's foot 6. The evidence strongly supports terbinafine as the most effective topical treatment with the shortest required duration.