What is the treatment for tinea pedis?

Treatment of Tinea Pedis

For tinea pedis, topical terbinafine 1% cream applied once daily for 1-2 weeks is the first-line treatment, offering faster clinical resolution than other agents with mycological cure rates of 84.2% compared to placebo. 1

First-Line Treatment Options

Topical Treatments (Preferred for Localized Infection)

• Terbinafine 1% cream:

  • Apply once daily for 1-2 weeks
  • Provides faster clinical resolution than other topical agents
  • Achieves mycological cure rates of 84.2% compared to 23.3% for placebo 1
  • Even a single application has shown 78% cure rates in some studies 2

• Alternative Topical Options:

  • Ciclopirox olamine 0.77% cream/gel: Apply twice daily for 4 weeks (clinical and mycological cure rates ~60% at end of treatment, 85% two weeks after) 1
  • Clotrimazole 1% cream: Apply twice daily for 2-4 weeks 1
  • Miconazole 2% cream: Apply twice daily for 2-4 weeks 1
  • Butenafine: Apply as directed 1

Severe or Extensive Infections

Oral Antifungal Therapy

For widespread, severe, or resistant cases:

• Terbinafine (oral):

  • 250 mg once daily for 1 week
  • Similar efficacy to 4 weeks of clotrimazole 1% cream but with faster resolution 1

• Itraconazole (oral):

  • 100 mg once daily for 2 weeks
  • 87% mycological cure rate
  • May have slightly higher relapse rate compared to terbinafine 1

• Griseofulvin (oral):

  • Adult dosage: 0.5 g daily (can be divided as 125 mg four times daily or 250 mg twice daily)
  • Pediatric dosage (>2 years): 10 mg/kg daily
  • Treatment duration for tinea pedis: 4-8 weeks 3
  • Requires longer treatment duration compared to other oral options

Important Diagnostic Considerations

1. Confirm diagnosis before initiating treatment:

   • Direct microscopic examination with potassium hydroxide (KOH)
   • Fungal culture
   • PCR testing (sensitivity 90.9%, specificity 94.1%) 1

2. Treatment can begin while awaiting confirmatory mycology if clinical signs are present 1

Adjunctive Measures and Prevention

• Concomitant topical therapy is usually required even with oral treatment 3
• Apply foot powder after bathing (reduces infection rates from 8.5% to 2.1%) 1
• Hygiene measures:
  • Thoroughly dry between toes after showering
  • Change socks daily
  • Periodically clean athletic footwear
  • Avoid sharing towels and personal items 1

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical resolution 1, 4
• The endpoint of treatment should be mycological cure, not just clinical improvement 1
• For chronic or severe cases, treatment may need to be extended 5

Special Considerations

• For mixed infections involving bacteria and yeast, combination therapy may be necessary as griseofulvin will not eradicate bacterial or yeast infections 3
• In cases with inflammation, agents with anti-inflammatory properties may be beneficial 5, 4
• Chronic "dry type" tinea pedis often requires systemic therapy as it may not respond well to topical treatments 5

Prevention of Recurrence

• Prophylactic use of antifungal powders in shoes and between toes after bathing 1, 6
• Examine and treat all household members for anthropophilic infections 1
• Consider discarding heavily contaminated footwear 1