Treatment of Tinea Web Space Infection
For tinea web space infection (tinea pedis interdigitalis), topical terbinafine 1% cream applied once daily for one week is the recommended first-line treatment, offering superior efficacy with shorter duration compared to azole alternatives. 1, 2
First-Line Topical Treatment
- Terbinafine 1% cream once daily for 1 week is the optimal regimen for uncomplicated web space tinea pedis, providing cure rates of 78% or higher due to its fungicidal action against dermatophytes 3, 2
- Terbinafine is FDA-approved for athlete's foot (tinea pedis) and relieves itching, burning, cracking, and scaling associated with these infections 1
- A film-forming solution formulation of 1% terbinafine allows for single-dose treatment, which may improve compliance and reduce recurrences 2
Alternative Topical Options
- Azole creams (such as clotrimazole 1%) require twice-daily application for 4 weeks to achieve similar cure rates, making them less convenient than terbinafine 4, 2
- Naftifine 1% demonstrates effectiveness with mycological cure rates significantly higher than placebo (RR 2.38, NNT 3) and clinical cure rates of RR 2.42 5
- Treatment should continue for at least one week after clinical clearing of infection to prevent relapse 4
When to Consider Systemic Therapy
- Oral terbinafine 250 mg daily for 2-4 weeks should be reserved for extensive infections, treatment failures, or immunocompromised patients 6, 7
- Weight-based dosing for oral terbinafine: <20 kg: 62.5 mg/day; 20-40 kg: 125 mg/day; >40 kg: 250 mg/day 6
- Itraconazole 50-100 mg daily for 2-4 weeks can be used as second-line systemic therapy if terbinafine is contraindicated or ineffective 6, 8
Management of Treatment Failure
- Assess compliance, drug absorption, organism sensitivity, and potential reinfection if initial therapy fails 6
- If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks 6, 7
- Switch to second-line therapy if no clinical improvement is observed after initial treatment course 6
Critical Adjunctive Measures
- Keep the skin dry and cool at all times, as moisture exacerbates web space infections 4, 9
- Clean contaminated personal items with disinfectant or 2% sodium hypochlorite solution 7
- Avoid sharing towels, clothing, or footwear with infected individuals 9
- Screen and treat household contacts if anthropophilic species are identified 6
Important Caveats
- Topical steroid-antifungal combinations may show higher clinical cure rates at end of treatment but are not recommended in clinical guidelines due to potential for skin atrophy and other steroid-related complications 4, 5
- Mycological cure, not just clinical response, is the definitive treatment endpoint and should guide follow-up 7
- The presence of maceration or secondary bacterial infection may require additional antimicrobial therapy beyond antifungals 9