What is the treatment for athlete's foot?

Treatment for Athlete's Foot

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

Location-Based Treatment with Terbinafine 1%

• Between the toes only: Apply twice daily (morning and night) for 1 week 2
• On the bottom or sides of the foot: Apply twice daily (morning and night) for 2 weeks 2

Alternative First-Line Option

• Ciclopirox olamine 0.77% cream/gel applied for 4 weeks (approximately 60% clinical and mycological cure at end of treatment, increasing to 85% cure two weeks post-treatment) 1

Treatment Algorithm

1. Start with topical therapy:

   • Terbinafine 1% cream has a mycological cure rate of 93.5% after 1 week 1
   • Apply as directed based on location of infection

2. If no improvement after initial treatment:

   • Consider compliance issues, suboptimal absorption, organism insensitivity, or reinfection 1
   • If clinical improvement but positive mycology, continue current therapy for 2-4 more weeks 1
   • If no clinical improvement, switch to second-line therapy 1

3. Second-line options:

   • Oral itraconazole 100 mg daily for 4 weeks 1
   • Oral terbinafine 250 mg (faster clinical resolution than topical treatments) 1

Special Considerations

For Complicated Cases

• 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 1

Prevention of Recurrence

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

Common Pitfalls to Avoid

1. Inadequate treatment duration: Follow the recommended treatment period based on location and severity
2. Neglecting environmental factors: Ensure proper foot hygiene and appropriate footwear
3. Misdiagnosis: The accuracy of clinical diagnosis of tinea pedis is low; consider KOH wet-mount examination of skin scrapings for confirmation in unclear cases 3
4. Overlooking risk factors: Be aware that male gender, athletes, obesity, and diabetes are risk factors for tinea pedis 1
5. Ignoring potential complications: Monitor for secondary bacterial infections, especially in diabetic patients

Monitoring and Follow-up

• If using oral terbinafine, monitor for potential hepatotoxicity or neutropenia 1
• For persistent cases despite appropriate treatment, consider culture or molecular testing to identify the specific pathogen 3
• Evaluate for complete resolution of symptoms and signs before discontinuing treatment

Athlete's foot is common (affecting approximately 17% of adults) but highly treatable with appropriate antifungal therapy and preventive measures 4.