What is the recommended treatment for Tinea pedis (athlete's foot)?

Treatment of Tinea Pedis (Athlete's Foot)

For most cases of tinea pedis, topical terbinafine 1% cream applied twice daily for 1-2 weeks is the recommended first-line treatment due to its high efficacy and convenient dosing regimen. 1, 2

First-Line Topical Treatment Options

• Terbinafine 1% cream:

  • For infections between the toes only: Apply twice daily (morning and night) for 1 week 2
  • For infections on the bottom or sides of the foot: Apply twice daily for 2 weeks 2
  • Provides high mycological cure rates (72% at week 6) with minimal side effects 3
  • Available as full prescription strength over-the-counter 2

• Ciclopirox olamine 0.77% cream/gel:

  • Apply twice daily to affected areas for 4 weeks 1
  • Superior to clotrimazole 1% cream in achieving both clinical and mycological cure (85% vs 16% two weeks after treatment) 1

• Clotrimazole 1% cream:

  • Apply twice daily for 4 weeks 1
  • Less effective than terbinafine but still a viable alternative 1, 4

Oral Treatment Options (For Severe or Resistant Cases)

• Oral terbinafine:

  • 250 mg once daily for 1 week 1
  • Offers faster clinical resolution compared to topical treatments 1
  • Similar efficacy to 4 weeks of clotrimazole 1% cream 1
  • Well-tolerated but monitor for rare adverse events (neutropenia, liver failure) 1

• Oral itraconazole:

  • 100 mg daily for 2 weeks 1
  • Similar mycological efficacy to terbinafine but may have slightly higher relapse rate 1
  • Better option for non-dermatophyte mold infections 1

Treatment Algorithm

1. For mild to moderate infections:

   • Start with topical terbinafine 1% cream twice daily 2
   • Duration: 1 week for interdigital infections, 2 weeks for plantar infections 2

2. For severe, extensive, or hyperkeratotic infections:

   • Consider combination of topical and oral antifungal therapy 5
   • Oral terbinafine 250 mg daily for 1 week is preferred for faster resolution 1

3. For infections with complications (bacterial superinfection, inflammation):

   • Consider agents with anti-inflammatory properties or combination therapy 6, 4
   • Treat both fungal and bacterial components if present 6

Prevention Measures

• Thoroughly dry between toes after bathing/showering 1
• Use foot powder after bathing (shown to reduce T. pedis rates from 8.5% to 2.1%) 1
• Change socks daily and clean athletic footwear periodically 1
• Wear well-fitting, ventilated shoes 2

Special Considerations

• For children under 12 years: Consult a doctor before using topical terbinafine 2
• For diabetic patients: More aggressive treatment may be needed as diabetes is a risk factor for tinea pedis 1
• For recurrent infections: Consider longer treatment courses and more stringent preventive measures 3
• For treatment failures: Verify diagnosis with microscopy/culture and consider switching to oral therapy 6, 4

Monitoring and Follow-up

• Treatment should continue for at least one week after clinical clearing of infection 4
• Recurrence rate is approximately 12.5% at 3 months after successful treatment 3
• If no improvement after appropriate therapy, consider alternative diagnoses or resistant infection 6