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 tinea pedis, with significantly higher cure rates than longer courses of other antifungal agents. 1, 2
First-Line Treatment Options
- For interdigital tinea pedis (between the toes): Apply terbinafine 1% cream twice daily (morning and night) for 1 week 2
- For plantar tinea pedis (bottom or sides of foot): Apply terbinafine 1% cream twice daily for 2 weeks 2
- Terbinafine 1% cream has demonstrated superior efficacy with 89.7% effective treatment rate compared to 73.1% for clotrimazole after 4 weeks of treatment 3
- Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks is an effective alternative, achieving approximately 60% clinical and mycological cure at end of treatment, and 85% two weeks after treatment 4, 1
- Ciclopirox gel is particularly beneficial for cases with maceration, inflammation and secondary bacterial infection due to its additional antibacterial and anti-inflammatory properties 5
Oral Therapy for Severe or Resistant Cases
- Oral terbinafine 250 mg once daily for 1 week offers faster clinical resolution compared to topical treatments and is indicated for severe or resistant cases 4, 1
- Oral terbinafine has similar efficacy to 4 weeks of topical clotrimazole but achieves faster clinical resolution 4
- Oral itraconazole 100 mg daily for 2 weeks is an alternative but may have a slightly higher relapse rate than terbinafine 4, 1
- Oral therapy should be reserved for severe disease, failed topical therapy, or immunocompromised patients 1
Prevention Measures
- Apply foot powder after bathing, which has been shown to reduce tinea pedis rates from 8.5% to 2.1% 4, 1
- Thoroughly dry between toes after showering 4, 1
- Change socks daily and clean athletic footwear periodically 4, 1
- Wear well-fitting, ventilated shoes 2
- Wear nonocclusive leather shoes or sandals and absorbent cotton socks 6
- Apply talcum or antifungal powder at least twice daily 6
- To prevent spread to the groin area (tinea cruris), cover active foot lesions with socks before wearing underwear 4
Important Considerations
- Risk factors include swimming, running (especially marathon runners), warm humid environments, male gender, obesity, and diabetes 4, 1
- Causative organisms are predominantly Trichophyton rubrum and Trichophyton mentagrophytes 4, 1
- Treatment failure may occur if all infected family members are not treated simultaneously 1
- Contaminated footwear can be a source of reinfection if not addressed 1
- Terbinafine is well-tolerated in children, though rare adverse events include occasional isolated neutropenia and rare liver failure (typically in people with preexisting liver disease) 4