From the Guidelines
Treatment for moccasin foot should involve applying terbinafine 1% cream daily for 1 week, as it has been shown to have a mycological cure rate of approximately 94% 1. When managing moccasin foot, it is essential to consider the severity of the infection and the patient's overall health.
- For mild to moderate cases, over-the-counter antifungal creams such as clotrimazole or butenafine can be effective alternatives, applied twice daily for 2-4 weeks 1.
- However, for severe or persistent infections, oral antifungal medications like itraconazole (100 mg daily for 2 weeks or 200 mg daily for 1 week) may be necessary and require a prescription, as they have been shown to be effective in adults for treating similar fungal infections 1. Some key considerations for managing moccasin foot include:
- Keeping feet clean and thoroughly dry, especially between toes
- Wearing breathable footwear and cotton socks
- Disinfecting shoes with antifungal powder or spray
- Avoiding walking barefoot in public areas It is crucial to note that the treatment approach may vary depending on the patient's age, as some medications, such as butenafine, are only approved for adults 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. The treatment for moccasin foot, also known as athlete's foot on the bottom or sides of the foot, is to apply terbinafine (TOP) twice a day (morning and night) for 2 weeks or as directed by a doctor 2.
From the Research
Treatment Options for Moccasin Foot
- Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, including moccasin foot 3
- Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 3
- Oral antifungal therapy, such as terbinafine, itraconazole, and fluconazole, may be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients 3
- Combined therapy with topical and oral antifungals may increase the cure rate 3
Specific Treatment Studies
- A study comparing terbinafine and clotrimazole in treating tinea pedis found that terbinafine was more effective in terms of mycological cure and effective treatment 4
- A Cochrane review found that terbinafine was more effective than griseofulvin in treating tinea pedis, and that terbinafine and itraconazole were more effective than no treatment 5
- A study comparing oral terbinafine with topical clotrimazole in interdigital tinea pedis found that oral terbinafine was as effective and well-tolerated as topical clotrimazole 6
- A study using 40% urea cream as an adjunct to topical antifungals in the treatment of moccasin tinea pedis found a 100% cure rate in 12 patients treated with topical 40% urea cream and ciclopirox cream concomitantly 7
Treatment Considerations
- The accuracy of clinical diagnosis of tinea pedis is low, and a KOH wet-mount examination of skin scrapings or fungal culture may be necessary to confirm the diagnosis 3
- Transmission of tinea pedis can occur through indirect contact with contaminated belongings of the affected patient, and prevention measures should be taken to avoid reinfection 3