What are the newest treatments for tinea pedis?

Newest Treatments for Tinea Pedis

Topical terbinafine 1% cream applied twice daily for 1 week is the most effective first-line treatment for tinea pedis, providing superior efficacy compared to longer courses of other antifungal agents. 1, 2

First-Line Topical Treatments

• Terbinafine 1% cream is the preferred first-line treatment, applied twice daily for 1 week, demonstrating fungicidal activity with high cure rates even with short-duration therapy 1, 3
• 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 1
• Clotrimazole 1% cream is widely available over-the-counter but less effective than terbinafine 1, 3
• Sertaconazole nitrate cream 2% is a newer imidazole agent with both fungicidal and fungistatic properties, plus additional anti-inflammatory and antipruritic effects 4

Treatment Based on Clinical Presentation

• For interdigital tinea pedis (most common form):
  • Topical terbinafine 1% cream twice daily for 1 week is most effective 1, 3
• For hyperkeratotic (moccasin-type) or extensive tinea pedis:
  • May require longer treatment duration or oral therapy 5, 6
• For vesiculobullous (inflammatory) tinea pedis:
  • Consider agents with anti-inflammatory properties like sertaconazole or combination therapy 5, 4

Oral Therapy for Severe or Resistant Cases

• Oral terbinafine 250 mg once daily for 1 week provides faster clinical resolution compared to topical treatments for severe cases 1, 6
• Oral itraconazole 100 mg daily for 2 weeks is an alternative with similar mycological efficacy to terbinafine but potentially higher relapse rates 1, 6
• Oral therapy should be reserved for:
  • Severe disease
  • Failed topical therapy
  • Concomitant onychomycosis
  • Immunocompromised patients 6

Prevention Strategies

• Apply foot powder after bathing to reduce recurrence rates 1
• Thoroughly dry between toes after showering 1
• Change socks daily and clean athletic footwear periodically 1
• Cover active foot lesions with socks before wearing underwear to prevent spread to the groin area 1

Important Clinical Considerations

• Accurate diagnosis is essential before initiating treatment - KOH preparation of skin scrapings is recommended as point-of-care testing 6
• Treatment should continue for at least one week after clinical clearing of infection 7
• Combined therapy with topical and oral antifungals may increase cure rates in resistant cases 6
• Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes 1
• Causative organisms are predominantly T. rubrum and T. mentagrophytes 1, 6

Pitfalls to Avoid

• Stopping treatment prematurely before complete eradication of infection can lead to recurrence 7
• Failing to treat all infected family members simultaneously can result in reinfection 8
• Neglecting to address contaminated footwear as a source of reinfection 8
• Using combination antifungal/steroid agents for extended periods can cause skin atrophy and other steroid-associated complications 7
• Untreated tinea pedis may progress to onychomycosis or acute bacterial cellulitis 4, 6