Treatment of Tinea Pedis
For interdigital tinea pedis, apply topical terbinafine 1% cream twice daily for 1 week, which provides superior efficacy compared to 4 weeks of other topical antifungals and is the recommended first-line treatment. 1, 2, 3
First-Line Topical Therapy
Terbinafine 1% cream is the preferred initial treatment due to its fungicidal mechanism and shorter treatment duration 1, 2:
- For interdigital tinea pedis (between the toes): Apply twice daily for 1 week 1, 3
- For plantar tinea pedis (bottom or sides of foot): Apply twice daily for 2 weeks 3
- Achieves 93.5% mycological cure rate at 4 weeks and 89.7% effective treatment rate, significantly superior to clotrimazole 4
- FDA-approved for patients 12 years and older 3
Alternative Topical Agents
If terbinafine is unavailable or contraindicated, consider these options:
- Ciclopirox olamine 0.77% cream/gel: Apply twice daily for 4 weeks, achieving 60% cure at treatment end and 85% two weeks post-treatment 1, 2
- Clotrimazole 1% cream: Apply twice daily for 4 weeks, though less effective than terbinafine (73% mycological cure vs 93.5%) 1, 4
Oral Therapy for Severe or Resistant Cases
Reserve systemic treatment for extensive disease, failed topical therapy, concomitant onychomycosis, or immunocompromised patients 2, 5:
- Oral terbinafine 250 mg once daily for 1 week: Provides similar mycological efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution 1, 2
- Oral itraconazole 100 mg daily for 2 weeks: Similar efficacy to oral terbinafine but may have slightly higher relapse rates 1, 2
Important Safety Considerations
- Monitor for rare but serious adverse events with oral terbinafine, including isolated neutropenia and liver failure, particularly in patients with preexisting liver disease 1, 5
Prevention Strategies
Implement these measures to reduce recurrence and transmission 1, 2:
- Apply foot powder after bathing (reduces infection rates from 8.5% to 2.1%) 1, 2
- Thoroughly dry between toes after showering 1, 2
- Change socks daily 1, 2
- Periodically clean athletic footwear 1, 2
- Cover active foot lesions with socks before wearing underwear to prevent spread to groin 1, 2
Common Pitfalls to Avoid
- Failing to treat all infected family members simultaneously can result in reinfection 2
- Neglecting contaminated footwear as a source of reinfection leads to recurrence 2
- Stopping treatment based on clinical improvement alone rather than mycological cure increases relapse risk 5
- Not examining other body sites (hands, groin, body folds) when diagnosing tinea pedis, as dermatophytes commonly cause concomitant infections at multiple sites 2