What is the treatment for athlete's foot?

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 interdigital athlete's foot, with superior cure rates compared to other antifungal agents. 1, 2

First-Line Treatment Options

• Topical terbinafine 1% cream should be applied twice daily for 1 week for interdigital (between the toes) tinea pedis 1, 2
• For athlete's foot on the bottom or sides of the foot, terbinafine 1% cream should be applied twice daily for 2 weeks 2
• Ciclopirox olamine 0.77% cream/gel is an effective alternative, achieving approximately 60% clinical and mycological cure at end of treatment and 85% two weeks after treatment 3, 1
• Clotrimazole 1% cream is less effective than terbinafine but is widely available over-the-counter and should be applied twice daily for 4 weeks 1, 4

Oral Therapy for Severe or Resistant Cases

• For severe or resistant cases, oral terbinafine 250 mg once daily for 1 week provides faster clinical resolution than topical treatments 3, 1
• Oral itraconazole 100 mg daily for 2 weeks is an alternative with similar efficacy to terbinafine but may have a slightly higher relapse rate 3, 1

Application Instructions

• Wash the affected area with soap and water and dry thoroughly before applying any medication 2, 4
• Apply a thin layer of the product over the affected area 4
• Pay special attention to spaces between the toes when treating interdigital tinea pedis 4
• Wash hands after each application 2

Prevention Measures

• Wear well-fitting, ventilated shoes and change shoes and socks at least once daily 2, 4
• Thoroughly dry between toes after showering 1
• Apply foot powder after bathing to reduce tinea pedis recurrence 1
• Avoid walking barefoot in communal areas like swimming pools, showers, and locker rooms 5
• To prevent spread to the groin area, cover active foot lesions with socks before wearing underwear 1

Special Considerations

• Risk factors for tinea pedis include swimming, running, warm humid environments, male gender, obesity, and diabetes 3, 1
• The predominant causative organisms are Trichophyton rubrum and Trichophyton mentagrophytes 3, 1
• Bacterial superinfection can occur in macerated interdigital spaces, requiring additional treatment 6
• While athlete's foot is not usually dangerous, it can cause discomfort, may be resistant to treatment, and can spread to other parts of the body or to other people 7

Treatment Algorithm

1. For mild to moderate interdigital tinea pedis: Terbinafine 1% cream twice daily for 1 week 1, 2
2. For plantar (bottom/sides of foot) tinea pedis: Terbinafine 1% cream twice daily for 2 weeks 2
3. If no improvement after 1-2 weeks or for severe cases: Consider oral terbinafine 250 mg daily for 1 week 3, 1
4. For patients who cannot tolerate terbinafine: Use ciclopirox olamine 0.77% or clotrimazole 1% cream 3, 1, 4

The evidence clearly demonstrates that topical antifungal treatments are significantly more effective than vehicle controls, with allylamines (like terbinafine) showing superior efficacy compared to azoles (like clotrimazole) 8. Maintaining dry feet through proper footwear and hygiene is essential for both treatment success and prevention of recurrence 1, 6.