What is the treatment for athlete's foot?

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, providing superior cure rates compared to longer courses of other antifungal agents. 1, 2

First-Line Treatment Options

• For interdigital tinea pedis (between the toes), apply topical terbinafine 1% cream twice daily (morning and night) for 1 week 1, 2
• For tinea pedis on the bottom or sides of the foot, apply topical terbinafine 1% cream twice daily for 2 weeks 2
• 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 3, 1
• Clotrimazole 1% cream is less effective than terbinafine but is widely available over-the-counter and can be used twice daily for 2-4 weeks 1, 4

Oral Therapy 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 week has similar efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution 3, 1
• Oral itraconazole 100 mg daily for 2 weeks has similar mycological efficacy to terbinafine but may have slightly higher relapse rate 3, 4

Clinical Presentation and Diagnosis

• Tinea pedis presents as fine scaly or vesiculopustular eruptions, often itchy, commonly affecting the spaces between toes 3, 4
• Three main clinical forms are recognized: interdigital (most common), hyperkeratotic (moccasin-type), and vesiculobullous (inflammatory) 5
• KOH wet-mount examination of skin scrapings from the active border of the lesion is recommended for diagnosis 5
• The predominant causative organisms are Trichophyton rubrum and Trichophyton mentagrophytes 3, 1

Prevention Measures

• Keep feet dry by thoroughly drying between toes after showering 1, 4
• Wear well-fitting, ventilated shoes and change socks at least once daily 2, 6
• Apply foot powder after bathing, which can reduce tinea pedis rates from 8.5% to 2.1% 1, 7
• Avoid walking barefoot in public showers, locker rooms, and swimming pool areas 6, 5
• Cover active foot lesions with socks before wearing underwear to prevent spread to the groin area 1, 4

Common Pitfalls and Special Considerations

• Failing to treat all infected family members simultaneously can result in reinfection 1, 4
• Neglecting to address contaminated footwear as a source of reinfection can lead to recurrence 1, 4
• Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes 3, 1
• Untreated tinea pedis may persist and progress, potentially leading to secondary bacterial infections 5, 7
• Bacterial overgrowth can complicate tinea pedis, especially in macerated cases, requiring both antifungal and antibacterial approaches 7