What is the treatment for wet, smelly, flaky feet, possibly due to fungal infections like athlete's foot or other skin conditions?

Treatment of Wet, Smelly, Flaky Feet

For wet, smelly, flaky feet consistent with athlete's foot (tinea pedis), apply topical terbinafine 1% cream twice daily for 1 week for interdigital (between-toes) infection, or twice daily for 2 weeks for infection on the bottom or sides of the foot. 1, 2

Immediate Treatment Approach

Topical Antifungal Therapy (First-Line)

• Terbinafine 1% cream is the preferred topical agent because it achieves cure with the shortest treatment duration compared to other antifungals 1
• Apply twice daily (morning and night) after washing feet with soap and water and drying completely 2
• Treatment duration: 1 week for interdigital infection, 2 weeks for plantar/side infection 2
• Alternative topical options if terbinafine unavailable: ciclopirox olamine 0.77% cream (achieves ~85% cure two weeks post-treatment) or clotrimazole 1% cream (less effective but widely available over-the-counter) 1

Address the "Wet" Component Immediately

• The wetness and smell indicate bacterial overgrowth superimposed on fungal infection - moisture accumulation stimulates aerobic diphtheroids and potentially gram-negative organisms like Pseudomonas 3
• Drying is the decisive element for symptom control 3
• Keep feet exposed to air as much as possible (wear sandals when feasible) to enhance water evaporation 3
• Thoroughly dry between toes after every shower or bathing 1
• Change socks at least once daily, preferably absorbent cotton socks 1, 4
• Wear well-fitting, ventilated shoes and change shoes daily 2, 4

Prevention of Reinfection

• Apply antifungal powder (containing miconazole, clotrimazole, or tolnaftate) to feet and inside shoes daily - this reduces recurrence rates from 8.5% to 2.1% 5, 1
• Discard old, moldy footwear if possible 5
• If discarding shoes is not feasible, place naphthalene mothballs in shoes, seal in plastic bag for minimum 3 days, then air out 5
• Alternative: spray terbinafine solution into shoes periodically 5
• Cover active foot lesions with socks before putting on underwear to prevent spread to groin area 1

When to Escalate to Oral Therapy

Reserve oral antifungals for severe disease, failed topical therapy after 2-4 weeks, concomitant nail infection, or immunocompromised patients 1

Oral Treatment Options

• Oral terbinafine 250 mg once daily for 1 week provides similar efficacy to 4 weeks of topical clotrimazole with faster resolution 1
• Oral itraconazole 100 mg daily for 2 weeks is an alternative with similar mycological efficacy 1

Critical Pitfalls to Avoid

• Failing to treat all infected family members simultaneously leads to reinfection - both tinea pedis and onychomycosis are contagious 5, 1
• Neglecting contaminated footwear as a reinfection source causes recurrence 1
• Not addressing the moisture/bacterial component will result in persistent symptoms despite antifungal treatment 3
• Sharing toenail clippers with family members spreads infection 5

Special Considerations

• The "wet, smelly" presentation suggests dermatophytosis complex (fungal infection plus bacterial overgrowth) rather than simple dermatophytosis 3
• Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes 1
• Most cases are caused by Trichophyton rubrum or T. mentagrophytes 1
• Up to 36% of athlete's foot cases may be asymptomatic, serving as reservoirs for transmission 6