What is the treatment for tinea pedis?

Treatment of Tinea Pedis

For uncomplicated tinea pedis, topical terbinafine 1% cream applied twice daily for 1 week is the recommended first-line treatment due to its superior efficacy compared to longer courses of other antifungal agents. 1, 2

First-Line Topical Treatment Options

• Terbinafine 1% cream applied twice daily for 1 week is more effective than longer courses of other antifungal agents, with mycological cure rates of 93.5% at 4 weeks 1, 2
• Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks achieves approximately 60% clinical and mycological cure at end of treatment, and 85% two weeks after treatment 1, 3
• Clotrimazole 1% cream applied twice daily for 4 weeks is less effective than terbinafine but is widely available over-the-counter, with mycological cure rates of 73.1% at 4 weeks 1, 2

Treatment Algorithm for Tinea Pedis

1. For mild to moderate interdigital tinea pedis:

   • Start with topical terbinafine 1% cream twice daily for 1 week 1, 4
   • Continue treatment until at least 1 week after clinical clearing of infection 5

2. For severe disease, failed topical therapy, or immunocompromised patients:

   • Oral terbinafine 250 mg once daily for 1 week (faster clinical resolution than topical treatments) 1, 6
   • Oral itraconazole 100 mg daily for 2 weeks (similar efficacy to terbinafine but slightly higher relapse rate) 1, 3
   • Oral griseofulvin 0.5g daily (125 mg four times daily, 250 mg twice daily, or 500 mg once daily) for 4-8 weeks for adults 7
   • For children over 2 years: griseofulvin 10 mg/kg daily in divided doses 7

Special Considerations

• Concomitant use of appropriate topical agents is usually required with oral therapy, particularly in treatment of tinea pedis 7
• Griseofulvin will not eradicate bacterial or yeast infections that may be present alongside dermatophytes in some forms of tinea pedis 7
• Risk factors for tinea pedis include swimming, running, warm humid environments, male gender, obesity, and diabetes 1, 3
• Failing to treat all infected family members simultaneously can result in reinfection 1

Prevention Measures

• Apply foot powder after bathing to reduce tinea pedis rates from 8.5% to 2.1% 1
• Thoroughly dry between toes after showering 1, 3
• Change socks daily and clean athletic footwear periodically 1
• Cover active foot lesions with socks before wearing underwear to prevent spread to the groin area 1
• Address contaminated footwear as a potential source of reinfection 1

Treatment Monitoring

• The definitive endpoint for adequate treatment should be mycological cure, not just clinical response 3
• Consider follow-up with repeat mycology sampling at the end of the standard treatment period 3
• Clinical relapse will occur if the medication is not continued until the infecting organism is eradicated 7

Common Pitfalls

• Treating only until clinical improvement rather than complete mycological cure can lead to recurrence 3, 7
• Neglecting to address contaminated footwear as a source of reinfection can lead to recurrence 1
• Using griseofulvin for non-dermatophyte infections (e.g., bacterial infections, candidiasis) will be ineffective as it only works against dermatophytes 7
• Using topical steroids alone without antifungal agents can worsen the infection 5