What is the treatment for athlete's foot?

Treatment of Athlete's Foot

Topical terbinafine 1% cream applied twice daily for 1 week is the most effective first-line treatment for athlete's foot (tinea pedis). 1, 2

First-Line Treatment Options

• Topical terbinafine 1% cream should be applied twice daily (morning and night) for 1 week for interdigital tinea pedis (between the toes) 1, 2
• For tinea pedis on the bottom or sides of the foot, apply terbinafine 1% cream 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 1

Treatment Algorithm

1. Initial diagnosis: Look for fine scaly or vesiculopustular eruption that is often itchy, commonly involving fissures and scaling between toes 3
2. First-line therapy: Apply topical terbinafine 1% cream twice daily for 1-2 weeks depending on location 1, 2
3. For persistent or severe cases: Consider oral antifungal therapy 3, 1

Oral Therapy for Severe or Resistant Cases

• Oral terbinafine 250 mg once daily for 1 week has similar efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution 3, 1
• Oral itraconazole 100 mg daily for 2 weeks has similar mycological efficacy to terbinafine but may have slightly higher relapse rate 3, 1

Prevention Measures

• Thoroughly dry between toes after showering 1
• Change socks daily and clean athletic footwear periodically 1
• Wear well-fitting, ventilated shoes 2
• Apply foot powder after bathing 1
• Wear sandals in locker rooms and shower facilities to prevent contact with infecting organisms 4

Special Considerations

• Risk factors 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
• To prevent spread to the groin area (jock itch), cover active foot lesions with socks before wearing underwear 1

Common Pitfalls and Caveats

• Failure to treat for the full recommended duration can lead to recurrence 3
• Bacterial superinfection may occur in macerated lesions, requiring additional antimicrobial treatment 5
• Occlusive footwear and excessive moisture promote fungal growth and can worsen symptoms 5
• Chronic or recurrent infections may indicate untreated fungal nail infection serving as a reservoir for reinfection 5