Treatment of Tinea Pedis
Topical terbinafine 1% cream applied twice daily for 1 week is the first-line treatment for interdigital tinea pedis due to its high efficacy and convenient dosing regimen. 1, 2
First-Line Topical Treatment Options
- Terbinafine 1% cream is FDA-approved for tinea pedis and should be applied twice daily (morning and night) for 1 week for interdigital tinea pedis or 2 weeks for infections on the bottom or sides of the foot 3
- Terbinafine has a fungicidal mode of action that enables shorter treatment duration compared to other antifungals 4
- Ciclopirox olamine 0.77% cream/gel is an effective alternative, achieving approximately 85% clinical and mycological cure two weeks after treatment 1, 2
- Clotrimazole 1% cream is less effective than terbinafine but is widely available over-the-counter and can be used as an alternative option 1, 2
Treatment Based on Clinical Presentation
- For interdigital tinea pedis: Apply terbinafine 1% cream twice daily for 1 week 3
- For moccasin-type (hyperkeratotic) tinea pedis: Apply terbinafine 1% cream twice daily for 2 weeks 3, 5
- For vesiculobullous (inflammatory) tinea pedis: Consider combination therapy with a topical corticosteroid and oral antifungal initially to reduce inflammation 6
- For interdigital tinea pedis with erosion or contact dermatitis: Begin with a combination of topical corticosteroid and oral antifungal, then switch to topical antifungal after complications resolve 6
Oral Treatment Options (For Severe or Resistant Cases)
- Oral therapy should be reserved for severe disease, failed topical therapy, concomitant onychomycosis, or immunocompromised patients 1, 5
- Oral terbinafine 250 mg once daily for 1-2 weeks offers faster clinical resolution compared to topical treatments 2, 7
- Oral itraconazole 100 mg daily for 2 weeks or 400 mg daily for 1 week is an effective alternative 2, 7
- Fluconazole 150 mg once weekly for 2-3 weeks can also be effective for tinea pedis 7
Prevention Measures
- Thoroughly dry between toes after bathing/showering 1, 2
- Apply foot powder after bathing to reduce recurrence 1
- Change socks daily and wear well-fitting, ventilated shoes 2, 3
- Clean athletic footwear periodically to prevent reinfection 1
- Treat all infected family members simultaneously to prevent reinfection 1
- Cover active foot lesions with socks before wearing underwear to prevent spread to the groin area 1
Treatment Pitfalls and Considerations
- Failing to treat for the full recommended duration can lead to recurrence, even if symptoms improve early 8
- Treatment should continue for at least one week after clinical clearing of infection 8
- Neglecting to address contaminated footwear as a source of reinfection can lead to recurrence 1
- Diabetic patients may require more aggressive treatment as diabetes is a risk factor for infection 2, 5
- The accuracy of clinical diagnosis of tinea pedis is low; consider KOH examination of skin scrapings for confirmation 5