From the Guidelines
To treat moccasin foot, terbinafine 1% cream applied daily for 1 week is the most effective treatment, with a mycological cure rate of approximately 94%. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. In the context of moccasin foot, the goal is to eradicate the fungal infection while minimizing the risk of adverse effects and promoting optimal foot health.
Treatment Options
- Topical antifungals: Terbinafine 1% cream is a highly effective treatment for moccasin foot, as demonstrated in a study published in Pediatrics in 2017 1.
- Alternative treatments: Butenafine and clotrimazole are also available as over-the-counter alternatives, but their efficacy and approval status may vary depending on the patient's age and other factors.
- Oral antifungals: Itraconazole (100 mg daily for 2 weeks or 200 mg daily for 1 week) has been shown to be effective in adults for treating tinea cruris, but its use in moccasin foot may require further evaluation.
Management Strategies
- Consistent treatment: It's crucial to continue treatment for the full prescribed duration, even if symptoms improve earlier, to ensure the fungus is fully eradicated.
- Foot care: Keeping feet clean and dry, washing daily with soap, drying thoroughly between toes, changing socks regularly, and wearing breathable footwear can help prevent the spread of the infection and promote healing.
- Prevention: Avoiding walking barefoot in public areas can help prevent the spread of fungal infections.
By prioritizing the most effective treatment option and incorporating good foot care practices, patients with moccasin foot can achieve optimal outcomes and improve their quality of life. The use of terbinafine 1% cream, as recommended in the study published in Pediatrics in 2017 1, is a highly effective treatment option that should be considered as the first line of treatment.
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. To treat moccasin foot, which is another term for athlete's foot on the bottom or sides of the foot, apply Terbinafine (TOP) twice a day (morning and night) for 2 weeks or as directed by a doctor 2.
- Key points:
- Wear well-fitting, ventilated shoes.
- Change shoes and socks at least once daily.
- Wash hands after each use.
From the Research
Treatment Options for Moccasin Foot
- Oral terbinafine has been shown to be effective in treating moccasin-type tinea pedis, with mycologic cure rates of 59% after 6 weeks of treatment and 65% at 2 weeks after treatment 3.
- Topical naftifine hydrochloride gel 2% has also been found to be effective, with mycologic cure rates of 65.8% at week 6, compared to 7.8% for the vehicle group 4.
- The use of 40% urea cream as an adjunct to topical antifungals has been evaluated, with a 100% cure rate achieved in 12 patients treated with 40% urea cream and ciclopirox cream concomitantly 5.
- Topical bifonazole has been studied, with a clinical improvement rate of 46.2% when used alone and 83.3% when used in combination with 10% urea ointment 6.
- Another study found that oral terbinafine was effective in treating moccasin tinea pedis, with 86% of patients who received terbinafine being mycologically negative at 8 weeks, compared to 7% of patients on placebo 7.
Comparison of Treatment Options
- The studies suggest that oral terbinafine and topical naftifine hydrochloride gel 2% are effective treatments for moccasin-type tinea pedis, with high mycologic cure rates 3, 4.
- The use of 40% urea cream as an adjunct to topical antifungals may also be effective, although the sample size was small 5.
- Topical bifonazole may be more effective when used in combination with 10% urea ointment, rather than alone 6.