From the Guidelines
Athlete's foot can be effectively treated with terbinafine 1% cream applied daily for 1 week, which has a mycological cure rate of approximately 94%. This treatment is approved for children 12 years and older, as stated in the study published in Pediatrics in 2017 1.
Key Points to Consider
- Apply the cream to the affected area daily for 1 week
- Keep feet clean and dry, washing daily with soap and water, then thoroughly drying, especially between toes
- Wear clean cotton socks and change them daily, and alternate shoes to allow them to dry completely between wearings
- For severe or persistent infections that don't respond to over-the-counter treatments within two weeks, prescription-strength medications like oral terbinafine or itraconazole may be necessary
Prevention and Treatment
Other over-the-counter alternatives include butenafine applied twice daily for 2 weeks and clotrimazole applied twice weekly for 4 weeks, but butenafine is only approved in adults 1.
Important Considerations
It is essential to note that the warm, moist environment between toes creates ideal conditions for the fungus to thrive, which is why keeping feet dry and allowing air circulation is crucial for both treatment and prevention.
Additional Measures
As mentioned in the British Journal of Dermatology in 2014, shoes can contain a large number of infective fungal elements, and it is best to discard all ‘old and mouldy’ footwear or eliminate fungal elements by putting naphthalene mothballs in the shoes and then leaving them enclosed within a tightly tied plastic bag for a minimum of 3 days 1.
From the FDA Drug Label
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. Uses • cures most athlete's foot (tinea pedis) Directions clean the affected area and dry thoroughly apply a thin layer of the product over affected area twice daily (morning and night) or as directed by a doctor supervise children in the use of this product for athlete's foot: pay special attention to spaces between the toes; wear well-fitting, ventilated shoes, & change shoes & socks at least once daily for athlete's foot & ringworm, use daily for 4 weeks;
The treatment for athlete's foot includes:
- Applying Terbinafine (TOP) twice a day for 1 week between the toes or 2 weeks on the bottom or sides of the foot, as directed by a doctor 2.
- Applying Miconazole (TOP) twice daily for 4 weeks 3.
- Wearing well-fitting, ventilated shoes and changing shoes and socks at least once daily 2 3.
- Cleaning the affected area and drying thoroughly before applying the product 3. Key points to consider when treating athlete's foot:
- Terbinafine (TOP) cures most athlete's foot (tinea pedis) 2.
- Miconazole (TOP) is not effective on the scalp or nails 3.
From the Research
Treatment Options for Athlete's Foot
- Topical treatments are available for fungal infections of the skin and nails of the foot, including allylamines, azoles, ciclopiroxolamine, tolnaftate, butenafine, and undecanoates 4
- Allylamines and azoles have been shown to be effective in treating athlete's foot, with allylamines producing slightly higher cure rates than azoles 4, 5
- Topical ciclopiroxolamine and butenafine have also been shown to be effective in treating fungal infections of the toenails, but require daily application for prolonged periods (at least 1 year) 4
- Oral antifungal agents such as fluconazole, itraconazole, and terbinafine can also be used to treat superficial fungal infections of the skin, including tinea pedis 6
Effectiveness of Topical Treatments
- Placebo-controlled trials have shown that topical treatments can produce significant reductions in treatment failure rates for skin infections, with risk ratios ranging from 0.19 to 0.33 4
- Meta-analysis of 11 trials comparing allylamines and azoles showed a risk ratio of treatment failure in favor of allylamines 4
- Terbinafine 1% cream has been shown to be more effective than clotrimazole 1% cream in treating tinea pedis, with higher rates of mycological cure and effective treatment 5
Safety and Efficacy
- The safety and efficacy of topical treatments for athlete's foot have been evaluated in several studies, with most treatments showing good safety profiles and high efficacy rates 4, 7, 5
- Improved foot hygiene, including the use of socks and hosiery, can also help to prevent the spread of athlete's foot 7