What is the recommended treatment for athlete's foot?

Treatment of Athlete's Foot

Topical terbinafine 1% cream applied twice daily for 1 week is the most effective first-line treatment for interdigital tinea pedis, with higher cure rates and faster resolution than 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 1, 2
• For plantar tinea pedis (bottom or sides of the foot): Apply terbinafine 1% cream twice daily for 2 weeks 2
• 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 less effective than terbinafine but is widely available over-the-counter and should be applied twice daily for 4 weeks 1, 3

Oral Therapy for Severe or Resistant Cases

Oral antifungal therapy should be reserved for:

• Severe disease
• Failed topical therapy
• Concomitant onychomycosis
• Immunocompromised patients 1, 4

Treatment options include:

• Oral terbinafine 250 mg once daily for 1 week (faster clinical resolution than topical treatments) 1
• Oral itraconazole 100 mg daily for 2 weeks (similar efficacy to terbinafine but slightly higher relapse rate) 1

Prevention Measures

• Wear well-fitting, ventilated shoes and change shoes and socks at least once daily 2, 3
• Thoroughly dry feet after washing, especially between the toes 5, 1
• Apply foot powder after bathing (can reduce tinea pedis rates from 8.5% to 2.1%) 1
• Avoid barefoot walking in public areas like swimming pools, locker rooms, and showers 5, 6
• Use talcum or antifungal powder at least twice daily 6
• Change socks daily and clean athletic footwear periodically 1
• To prevent spread to the groin area (jock itch), put on socks before underwear 1

Clinical Considerations

• Tinea pedis is most commonly caused by Trichophyton rubrum and Trichophyton mentagrophytes/interdigitale 1, 4
• Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes 1
• The prevalence is higher in adolescents and adults than in children, with peak incidence between 16-45 years 4
• Clinical diagnosis alone has low accuracy; KOH wet-mount examination of skin scrapings from the active border is recommended for confirmation 4
• Untreated infections may persist, progress, or spread to other body parts or people 7
• Secondary bacterial infections can occur in affected feet 7

Common Pitfalls to Avoid

• Failing to treat for the full recommended duration even if symptoms improve quickly 2, 3
• Not addressing all infected family members simultaneously, which can lead to reinfection 1
• Neglecting to treat contaminated footwear as a source of reinfection 1
• Misdiagnosing contact dermatitis as fungal infection (they can present similarly but require different treatments) 8
• Using the same antifungal treatment for all types of tinea pedis without considering the specific pattern (interdigital vs. plantar) 2