Treatment of Athlete's Foot (Tinea Pedis)
Topical terbinafine 1% cream applied twice daily for 1 week is the most effective first-line treatment for athlete's foot, providing superior cure rates compared to longer courses of other antifungal agents. 1
First-Line Treatment Options
Interdigital Tinea Pedis (Between the Toes)
- Apply terbinafine 1% cream twice daily (morning and night) for 1 week 2, 1
- Terbinafine has been shown to be significantly more effective than clotrimazole with cure rates of 93.5% vs 73.1% at 4 weeks 3
- Terbinafine's fungicidal action provides higher efficacy with shorter duration therapy compared to fungistatic agents 4
Plantar Tinea Pedis (Bottom or Sides of Foot)
- Apply terbinafine 1% cream twice daily for 2 weeks 2
- For more extensive or hyperkeratotic (moccasin-type) infections, longer treatment duration is necessary 5
Alternative Topical Options
- Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks (60% cure rate at end of treatment, 85% two weeks after treatment) 6
- Miconazole cream applied twice daily for 4 weeks 7
- Clotrimazole 1% cream applied twice daily for 4 weeks (less effective than terbinafine but widely available over-the-counter) 1, 3
Oral Therapy for Severe or Resistant Cases
Oral terbinafine 250 mg once daily for 1 week provides faster clinical resolution than topical treatments and is indicated for:
Oral itraconazole 100 mg daily for 2 weeks is an alternative with similar mycological efficacy to terbinafine but may have slightly higher relapse rates 6, 1
Combined oral and topical therapy may increase cure rates in resistant cases 5
Prevention Measures
- Thoroughly dry between toes after bathing/showering 6, 1
- Change socks daily and wear well-fitting, ventilated shoes 6, 2
- Apply foot powder after bathing (has been shown to reduce tinea pedis rates from 8.5% to 2.1%) 6, 1
- Periodically clean athletic footwear 6, 1
- To prevent spread to the groin area (tinea cruris), put on socks before underwear 6
Special Considerations
- Risk factors include swimming, running (especially marathon runners), warm humid environments, male gender, obesity, and diabetes 6, 1
- Causative organisms are predominantly Trichophyton rubrum and Trichophyton mentagrophytes 6, 5
- Single-dose terbinafine 1% film-forming solution has shown 63% effective treatment rate at 6 weeks with only 12.5% recurrence at 3 months, offering a convenient alternative for some patients 8
- Untreated infections may persist and progress to more severe forms 5
Common Pitfalls to Avoid
- Relying solely on clinical diagnosis without mycological confirmation (accuracy of clinical diagnosis is low) 5
- Discontinuing treatment prematurely when symptoms improve but before complete eradication 5
- Failing to address predisposing factors like occlusive footwear or excessive moisture 6, 1
- Not treating all affected family members, leading to reinfection 5