What is the recommended treatment for athlete's foot in a child?

Treatment of Athlete's Foot in Children

For athlete's foot (tinea pedis) in children, topical terbinafine 1% cream applied twice daily for 1 week is the recommended first-line treatment for interdigital infections, while a 2-week course is needed for infections on the bottom or sides of the foot. 1, 2

First-Line Treatment Options

• For children 12 years and older, topical terbinafine 1% cream should be applied twice daily (morning and night) for 1 week for infections between the toes, or 2 weeks for infections on the bottom or sides of the foot 2
• For children under 12 years, consult a doctor before using terbinafine 2
• Ciclopirox olamine 0.77% cream/gel is another effective option, applied twice daily for 4 weeks, achieving approximately 60% clinical and mycological cure at end of treatment and 85% two weeks after treatment 3, 1
• Clotrimazole 1% cream is available over-the-counter but requires a longer treatment course (4 weeks) and has lower efficacy than terbinafine 3, 1

Treatment for Severe or Resistant Cases

• For severe, extensive, or treatment-resistant cases, oral antifungal therapy may be considered 1, 4
• Oral terbinafine offers faster clinical resolution than topical treatments and can be given for shorter periods 3
• Terbinafine is well-tolerated in children, though rare adverse events include isolated neutropenia and liver failure (typically in those with preexisting liver disease) 3
• Oral therapy should only be used for severe disease, failed topical therapy, concomitant onychomycosis, or in immunocompromised patients 1, 4

Application Instructions

• Wash the affected area with soap and water and dry completely before applying any medication 2
• For terbinafine, use the tip of the cap to break the seal and open the tube 2
• Apply the medication to the affected area and surrounding skin 2
• Wash hands thoroughly after application 2

Prevention Measures

• Apply foot powder after bathing (has been shown to reduce tinea pedis rates from 8.5% to 2.1%) 3, 1
• Ensure thorough drying between toes after showering 3, 1
• Change socks daily and wear well-fitting, ventilated shoes 3, 2
• Clean athletic footwear periodically 3, 1
• Avoid walking barefoot in locker rooms and shower floors 3
• Cover active lesions with socks before wearing underwear to prevent spread to the groin area 3, 1

Special Considerations

• Tinea pedis is less common in children than in adolescents and adults, with peak incidence between 16-45 years 4
• Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes 3, 1
• The accuracy of clinical diagnosis is low; if diagnosis is uncertain, a KOH wet-mount examination of skin scrapings from the active border of the lesion is recommended 4
• The predominant causative organisms are Trichophyton rubrum and Trichophyton mentagrophytes 3
• Untreated infections may persist and progress, potentially spreading to other body sites including nails 4
• Treatment of all infected family members simultaneously is important to prevent reinfection 1