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 (tinea pedis) due to its superior efficacy and shorter treatment duration compared to other antifungal agents. 1

First-Line Treatment Options

Location-Specific Treatment with Terbinafine 1% Cream

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

Alternative First-Line Options

• Ciclopirox olamine 0.77% cream/gel applied for 4 weeks 1

Treatment Algorithm

1. Begin with topical therapy for uncomplicated cases:

   • Terbinafine 1% cream has a mycological cure rate of 93.5% after 1 week 1
   • Apply to affected areas after thoroughly washing and drying feet 2

2. If no improvement after 2-4 weeks, consider:

   • Switching to second-line therapy 1
   • Evaluating for compliance issues, suboptimal absorption, organism insensitivity, or reinfection 1

3. For severe or resistant cases, consider oral antifungal therapy:

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

Special Considerations

High-Risk Populations

• 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

Prevention of Recurrence

• Wear well-fitting, ventilated shoes 2
• Change shoes and socks at least once daily 2
• Apply antifungal powders to shoes and feet 1
• Thoroughly dry between toes after bathing 1
• Treat all infected family members simultaneously to prevent reinfection 1

Common Pitfalls to Avoid

1. Inadequate treatment duration: Continue treatment for the full recommended course even if symptoms improve quickly

2. Neglecting environmental factors: Failure to address contaminated footwear and shared surfaces can lead to reinfection 1

3. Missing secondary bacterial infections: Be vigilant for signs of bacterial superinfection, especially in diabetic patients 1

4. Incorrect diagnosis: The accuracy of clinical diagnosis of tinea pedis is low; consider KOH examination of skin scrapings from the active border of the lesion for confirmation 3

5. Stopping treatment too soon: If clinical improvement occurs but mycology remains positive, continue current therapy for 2-4 more weeks 1

Athlete's foot affects approximately 17% of adults at any given time 4, with a higher prevalence in males and those aged 16-45 years 3. With appropriate antifungal treatment, the prognosis is good, but untreated infections may persist and progress 3.