What is the treatment for tinea pedis?

Treatment of Tinea Pedis

Tinea pedis (athlete's foot) should be treated with topical terbinafine 1% cream applied twice daily for 1 week, which is more effective than longer courses of other antifungal agents. 1, 2

First-Line Treatment Options

Topical Antifungal Agents

• Terbinafine 1% cream: Apply twice daily for 1 week for interdigital tinea pedis; for infections on the bottom or sides of the foot, apply twice daily for 2 weeks 3

  • Provides superior mycological cure rates (93.5%) compared to clotrimazole (73.1%) 2
  • Fungicidal (rather than fungistatic) action allows for shorter treatment duration 4
  • Approved for adults and children 12 years and older 3

• Ciclopirox olamine 0.77% cream/gel: Apply twice daily for 4 weeks

  • Effective against common causative organisms (T. rubrum, T. mentagrophytes, E. floccosum) 1
  • Achieves approximately 60% clinical and mycological cure at end of treatment, and 85% two weeks after treatment 1

• Clotrimazole 1% cream: Apply twice daily for 4 weeks

  • Less effective than terbinafine but widely available over-the-counter 1, 2

Oral Therapy for Severe or Resistant Cases

• Oral terbinafine: 250 mg once daily for 1 week

  • Similar efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution 1, 5
  • Well-tolerated in children, though rare adverse events include isolated neutropenia and liver failure (particularly in those with preexisting liver disease) 1

• Oral itraconazole: 100 mg daily for 2 weeks

  • Similar mycological efficacy to terbinafine but may have slightly higher relapse rate 1

Treatment Algorithm

1. For uncomplicated interdigital tinea pedis:

   • Start with topical terbinafine 1% cream twice daily for 1 week 2
   • Continue treatment for at least one week after clinical clearing of infection 6

2. For plantar (moccasin-type) tinea pedis:

   • Topical terbinafine 1% cream twice daily for 2 weeks 3

3. For extensive or resistant infections:

   • Consider oral terbinafine 250 mg daily for 1 week 1, 5

4. For treatment failures:

   • Consider switching to oral itraconazole 100 mg daily for 2 weeks 1

Prevention Measures

• Apply foot powder after bathing (has been shown to reduce tinea pedis rates from 8.5% to 2.1%) 1
• Thoroughly dry between toes after showering 1
• Change socks daily 1
• Clean athletic footwear periodically 1
• Wear well-fitting, ventilated shoes 3

Special Considerations

• Risk factors: Swimming, running (especially marathon running), warm humid environments, male gender, obesity, and diabetes 1
• Causative organisms: Predominantly T. rubrum and T. mentagrophytes 1
• Inflammatory lesions: May benefit from agents with inherent anti-inflammatory properties or combination antifungal/steroid agents (use with caution due to potential for atrophy) 6
• Prevention of spread: To prevent spread to the groin area (tinea cruris), cover active foot lesions with socks before wearing underwear 1