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

From the Guidelines

Tinea pedis is best treated with topical antifungal medications such as terbinafine 1% cream applied daily for 1 week, which has been shown to be effective in treating similar fungal infections with a mycological cure rate of approximately 94% 1. When managing tinea pedis, it is essential to consider the treatment options that prioritize morbidity, mortality, and quality of life.

• Topical antifungal medications are the first line of treatment, with terbinafine 1% cream being a viable option, as seen in its effectiveness in treating T cruris 1.
• Other over-the-counter alternatives, such as butenafine and clotrimazole, can also be used, but their approval and effectiveness may vary depending on the patient's age and the specific fungal infection being treated 1.
• Oral antifungal medications like itraconazole may be considered for severe or resistant cases, but their use should be carefully evaluated based on the patient's overall health and potential side effects 1.
• In addition to antifungal treatment, preventive measures such as keeping feet clean and dry, wearing breathable footwear, changing socks daily, and using antifungal powder in shoes are crucial in reducing recurrence and creating an environment unfavorable for fungal growth.
• The treatment aims to eliminate the fungal infection while improving the patient's quality of life by reducing symptoms such as scaling, itching, burning, and blistering.
• It is essential to note that the treatment of tinea pedis should prioritize the patient's overall health and well-being, taking into account potential interactions with other medications and underlying health conditions 1.

From the FDA Drug Label

• cures most athlete's foot (tinea pedis) ▪ 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 tinea pedis (athlete's foot) with terbinafine (TOP) involves applying the medication twice a day for a specified duration, which is:

• 1 week for infection between the toes
• 2 weeks for infection on the bottom or sides of the foot 2 The medication is used to cure most athlete's foot (tinea pedis) and relieve accompanying symptoms such as itching, burning, cracking, and scaling 3

From the Research

Tinea Pedis Overview

• Tinea pedis, also known as athlete's foot, is a common fungal infection of the skin, with various clinical manifestations 4.
• It is estimated that approximately 3% of the world population have tinea pedis, with a higher prevalence in adolescents and adults than in children 4.
• The peak age incidence is between 16 and 45 years of age, and it is more common amongst males than females 4.

Causes and Transmission

• Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale 4.
• Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient 4.

Clinical Forms

• Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory) 4.
• The accuracy of clinical diagnosis of tinea pedis is low, and a KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing 4.

Treatment

• Superficial or localized tinea pedis usually responds to topical antifungal therapy 4.
• Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients 4.
• Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis, with examples of topical antifungal agents including allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine 4.
• Terbinafine has been shown to be effective in treating tinea pedis, with a cure rate of 78% achieved in patients with tinea pedis after a single application of 1% terbinafine cream 5.
• Terbinafine 1% cream applied twice daily for 1 week was significantly superior to a 4-week course of clotrimazole 1% cream for treating this common mycosis 5, 6.
• Oral terbinafine 250 mg once daily for 1 week is as effective and as well tolerated as 1% clotrimazole cream applied twice daily for 4 weeks in the treatment of interdigital tinea pedis 7.