From the Guidelines
To treat athlete's foot, start with an over-the-counter antifungal medication such as clotrimazole, miconazole, or terbinafine, applying the cream, spray, or powder to the affected area twice daily for at least two weeks, continuing for one week after symptoms disappear. This approach is based on the understanding that Tinea pedis (athlete's foot) is caused by dermatophyte fungi, predominantly T rubrum and T mentagrophytes, which thrive in warm, humid environments 1. The infection can be prevalent among individuals who participate in sports, especially swimmers and runners, with documented infections in up to 22% of marathon runners 1.
When selecting an over-the-counter antifungal medication, options like terbinafine 1% cream applied daily for 1 week have shown effectiveness in treating similar fungal infections, such as T cruris, with a mycological cure rate of approximately 94% 1. However, for Tinea pedis, applying the medication twice daily for at least two weeks is recommended to ensure the fungus is completely eliminated.
In addition to medication, maintaining good foot hygiene is crucial in treating and preventing the recurrence of athlete's foot. This includes:
- Keeping feet clean and dry by washing them daily with soap and water
- Drying thoroughly, especially between the toes
- Changing socks daily
- Wearing breathable footwear
- Avoiding walking barefoot in public areas like pools and showers
For severe cases that do not respond to over-the-counter treatments within two weeks, consulting a doctor is necessary. The doctor may prescribe stronger antifungal medications like oral terbinafine or itraconazole, which have been shown to be effective in treating fungal infections and are superior to other oral treatments like griseofulvin 1.
From the FDA Drug Label
Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor.
The treatment for Tinea pedis (Athlete's foot) is to apply terbinafine (TOP):
- Between the toes only: twice a day for 1 week
- On the bottom or sides of the foot: twice a day for 2 weeks It is also recommended to wear well-fitting, ventilated shoes and change shoes and socks at least once daily 2
From the Research
Treatment Options for Tinea Pedis
- Topical antifungal agents, such as terbinafine and clotrimazole, are commonly used to treat tinea pedis 3, 4, 5, 6
- Oral griseofulvin may be prescribed for more resistant cases 3
- Preventive measures include keeping the feet dry, wearing nonocclusive leather shoes or sandals and absorbent cotton socks, and applying talcum or antifungal powder at least twice daily 3
Comparison of Treatment Efficacy
- Terbinafine 1% cream has been shown to be more effective than clotrimazole 1% cream in treating tinea pedis, with mycological cure rates of 93.5% and 73.1%, respectively 4
- Terbinafine has also been compared to its vehicle (placebo) and shown to be significantly more effective, with 78% of patients achieving a combined mycologic and clinical cure at the end of therapy 5
Treatment Duration and Severity
- The severity of tinea pedis infection determines the course of treatment required, with mild infections potentially resolved using a topical agent and more severe presentations requiring combination therapy or systemic antifungal therapy 7
- Short-duration therapy with terbinafine has been shown to be effective in treating tinea pedis, with cure rates of > or = 80% achieved after 1-2 weeks of treatment 6