What is the diagnosis and treatment for Tinea pedis (Athlete's foot)?

From the Guidelines

Tinea pedis, commonly known as athlete's foot, should be treated with 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 achieving both clinical and mycological cure 1. The diagnosis of Tinea pedis is typically based on clinical presentation, including symptoms such as itching, burning, and cracking of the skin on the feet.

• Risk factors for Tinea pedis include obesity and diabetes, which can increase the likelihood of developing the infection 1.
• The infection is caused by dermatophytes, such as T rubrum, T mentagrophytes, and Epidermophyton floccosum, which feed on keratin in the skin.
• Treatment options for Tinea pedis include topical antifungal medications, such as ciclopirox olamine cream or gel, which has been shown to be superior to 1% clotrimazole cream or ciclopirox vehicle in achieving both clinical and mycological cure 1.
• In addition to topical treatment, it is essential to keep feet clean and dry, wear breathable footwear, change socks daily, and use antifungal powder in shoes to prevent the spread of the infection.
• Prevention measures include avoiding walking barefoot in public areas, thoroughly drying feet after bathing, and not sharing footwear or towels with others.
• Without proper treatment, Tinea pedis can spread to other body parts or develop into a more serious bacterial infection, highlighting the importance of prompt and effective treatment 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. Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions

The diagnosis of Tinea pedis (Athlete's foot) is not explicitly stated in the drug label, but the treatment involves:

• Applying terbinafine cream twice a day (morning and night) for 1 week for infections between the toes, or 2 weeks for infections on the bottom or sides of the foot
• Wearing well-fitting, ventilated shoes and changing shoes and socks at least once daily
• Washing the affected skin with soap and water and drying completely before applying the cream 2 The drug label states that terbinafine cures most athlete's foot (tinea pedis) and relieves itching, burning, cracking and scaling that accompany the condition 3

From the Research

Diagnosis of Tinea Pedis

• Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale 4
• The accuracy of clinical diagnosis of tinea pedis is low, and a KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing 4
• The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings 4

Treatment of Tinea Pedis

• Superficial or localized tinea pedis usually responds to topical antifungal therapy 4
• Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis 4
• Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine 4
• Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients 4
• Terbinafine has been shown to be effective in treating tinea pedis, with a cure rate of 78% achieved in patients with tinea pedis after a single application of 1% terbinafine cream 5
• A study comparing terbinafine 1% cream with clotrimazole 1% cream found that terbinafine was significantly superior to clotrimazole in treating tinea pedis 6
• A meta-analysis of topical terbinafine for the treatment of tinea pedis found that terbinafine was highly effective, with a mycologic cure rate significantly superior to placebo 7
• A single-dose terbinafine 1% formulation has been shown to be effective and safe in treating tinea pedis, with an effective treatment rate of 63% at week 6 8