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

Treatment of Athlete's Foot (Tinea Pedis)

For uncomplicated athlete's foot, apply topical terbinafine 1% cream twice daily for 1 week if infection is between the toes, or twice daily for 2 weeks if on the bottom or sides of the foot. 1

First-Line Topical Treatment

• Terbinafine 1% cream is the preferred topical agent, applied twice daily (morning and night) with duration based on location 1:

  • Between the toes: 1 week of treatment 1
  • Bottom or sides of foot: 2 weeks of treatment 1
  • Clinical studies demonstrate 89% combined mycologic and clinical cure rates at 2-week follow-up 2

• Before applying medication, wash affected skin with soap and water and dry completely 1

• Wear well-fitting, ventilated shoes and change shoes and socks at least once daily 1

Oral Therapy for Extensive or Refractory Cases

When topical therapy fails or infection is extensive, escalate to systemic treatment:

• Oral itraconazole is the recommended first-line systemic agent, using pulse dosing of 200-400 mg per day for 1 week per month 3

• Alternative continuous dosing: itraconazole 100 mg daily for 2 weeks for extensive tinea pedis 3

• Take itraconazole with food and acidic pH for optimal absorption 3

• Fluconazole 150 mg once weekly as pulse therapy is less effective than terbinafine or itraconazole but can serve as an alternative option 3

• Monitor liver function tests at baseline and during prolonged therapy, especially with itraconazole 3

Critical Adjunctive Measures to Prevent Recurrence

Treatment of the feet alone without addressing these factors leads to high recurrence rates:

• Apply foot powder after bathing, which reduces recurrence from 8.5% to 2.1% 3

• Change socks daily and clean athletic footwear periodically to prevent reinfection 3

• Examine and treat concomitant onychomycosis (nail infection), as it serves as a reservoir for reinfection 3

• Check for dermatophyte infection at other body sites (present in 25% of cases) and treat all infected family members simultaneously 3

Management of Treatment Failure

Before assuming true treatment failure:

• Obtain fungal cultures to verify treatment failure; consider discontinuing antifungals for a few days to optimize specimen collection 3

• Poor compliance, inadequate drug penetration, bacterial superinfection, or reinfection from nails/footwear are more common causes of apparent treatment failure than drug resistance 3

• Consider culture at end of treatment to confirm mycological clearance 3

Common Pitfalls to Avoid

• Do not treat feet in isolation—failure to address nail involvement or other body sites leads to recurrence 3

• Do not assume treatment failure is due to drug resistance alone without investigating compliance and reinfection sources 3

• Do not neglect footwear hygiene and daily sock changes, as these are essential for preventing reinfection 3, 1