What is the treatment for tinea pedis (Athlete's foot)?

From the Guidelines

Tinea pedis can be effectively treated with ciclopirox olamine cream or gel (0.77%) applied twice daily to the affected areas for 4 weeks, which has been shown to be superior to 1% clotrimazole cream in achieving both clinical and mycological cure. This treatment approach is based on a randomized controlled trial in adults, which demonstrated the efficacy of ciclopirox olamine in eradicating T pedis, with a clinical and mycological cure rate of approximately 60% at the end of treatment and 85% two weeks after treatment 1.

Key Considerations

• Obesity and diabetes are additional risk factors for T pedis, and patients with these conditions may require closer monitoring and more aggressive treatment 1.
• It is essential to keep feet clean and dry, wear breathable footwear, change socks daily, and avoid walking barefoot in public areas to prevent reinfection.
• Antifungal medications work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell survival.
• If symptoms worsen, show signs of bacterial infection (increased redness, warmth, swelling), or don't improve after two weeks of treatment, consult a healthcare provider for further evaluation.

Treatment Options

• Ciclopirox olamine cream or gel (0.77%) applied twice daily to the affected areas for 4 weeks
• Alternative options, such as 1% clotrimazole cream, may be considered, but ciclopirox olamine has been shown to be more effective 1.

From the FDA Drug Label

• cures most athlete's foot (tinea pedis) Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor.

The treatment for tinea pedis (athlete's foot) with terbinafine (TOP) involves:

• Applying the medication twice a day (morning and night)
• For 1 week if the infection is between the toes
• For 2 weeks if the infection is on the bottom or sides of the foot
• Wearing well-fitting, ventilated shoes and changing shoes and socks at least once daily 2 The medication cures most athlete's foot (tinea pedis) and relieves itching, burning, cracking and scaling that accompany the condition 2

From the Research

Treatment Options for Tinea Pedis

• Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, with options including allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 3, 4, 5, 6, 7.
• Terbinafine has been shown to be highly effective in treating tinea pedis, with a cure rate of 78% achieved in patients with tinea pedis after a single application of 1% terbinafine cream 3.
• Topical terbinafine has also been compared to clotrimazole for the treatment of tinea pedis, with terbinafine 1% cream applied twice daily for 1 week being significantly superior to a 4-week course of clotrimazole 1% cream 3, 4.
• The efficacy and safety of various topical formulations of terbinafine in tinea pedis have been validated in several clinical trials, with no significant differences in efficacy found amongst different formulations of terbinafine, treatment durations, or frequencies of application 5.
• Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients, with options including terbinafine, itraconazole, and fluconazole 6, 7.

Duration of Treatment

• Topical antifungal therapy is usually applied once to twice daily for 1-6 weeks, with treatment continuing for at least one week after clinical clearing of infection 6, 7.
• Terbinafine has been shown to achieve mycological cure more rapidly than clotrimazole, with a median duration of treatment of 1 week compared to 2 weeks for active controls 4, 5.

Safety and Tolerability

• Terbinafine is very well tolerated in any topical pharmaceutical formulation, with no significant difference in the risk of adverse events compared to placebo or active controls 4, 5.
• The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent, which should be used with caution due to their potential for causing atrophy and other steroid-associated complications 6.