From the Guidelines
Terbinafine cream or gel is the most effective topical antifungal for tinea pedis, with a recommended application of a thin layer to the affected area and surrounding skin once or twice daily for 1-2 weeks. This recommendation is based on the fact that terbinafine has both fungicidal and fungistatic properties, working by inhibiting squalene epoxidase and disrupting ergosterol synthesis in the fungal cell membrane, leading to fungal cell death 1. According to a study published in Pediatrics in 2017, oral terbinafine has similar efficacy to clotrimazole 1% cream, but with faster clinical resolution 1. Although the study discusses oral terbinafine, its mechanism of action and effectiveness can be extrapolated to its topical form.
Other effective options for treating tinea pedis include:
- Clotrimazole (Lotrimin)
- Miconazole (Micatin)
- Butenafine (Mentax) These alternatives can be applied twice daily for 2-4 weeks. However, terbinafine is preferred due to its faster action compared to azole antifungals. For best results, it is essential to keep feet clean and dry, wear breathable footwear, change socks daily, and treat all footwear with antifungal powder to prevent reinfection. If symptoms persist beyond 2 weeks of treatment or frequently recur, oral antifungal therapy may be necessary. Another study published in the same journal in 2017 supports the use of terbinafine 1% cream for treating T cruris, with a mycological cure rate of approximately 94% 1, further solidifying its effectiveness as a topical antifungal.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - 30 g Carton Cures Most Athlete's Foot Terbinafine Hydrochloride Cream 1% Antifungal Cream Full Prescription Strength NET WT 1 oz (30 g) Principal Display Panel TopCare Miconazorb AF ANTIFUNGAL POWDER MICONAZOLE NITRATE 2%/ ANTIFUNGAL Cures Most Athlete's Foot, Jock Itch & Ringworm Relieves Itching, Burning, Scaling & Chafing Comforts & Refreshes Absorbs Moisture Talc-Free NET WT 2.5 OZ (71 g) The most effective topical antifungal for tinea pedis (athlete's foot) is terbinafine 2 or miconazole 3, as both are stated to "Cure Most Athlete's Foot".
- Terbinafine and miconazole are both effective options, but the provided information does not specify which one is more effective.
- The choice between terbinafine and miconazole may depend on individual patient needs and circumstances, but this information is not provided in the drug labels.
From the Research
Topical Antifungal Treatments for Tinea Pedis
- Tinea pedis, also known as athlete's foot, is a common fungal infection that can be effectively treated with topical antifungal agents 4.
- Terbinafine is a widely used topical antifungal that has been shown to be highly effective in treating tinea pedis, with cure rates of up to 78% after a single application of 1% terbinafine cream 4.
Efficacy of Terbinafine Compared to Other Treatments
- Terbinafine has been compared to clotrimazole in several studies, with results showing that terbinafine is significantly superior to clotrimazole in treating tinea pedis 4, 5.
- A meta-analysis of 19 studies found that terbinafine had a significantly higher mycologic cure rate compared to placebo, and was also effective in treating tinea pedis with a shorter duration of treatment compared to active controls 6.
- Terbinafine 1% solution has also been shown to be effective in treating interdigital tinea pedis and tinea corporis or tinea cruris, with efficacy rates of 66% and 65%, respectively 7.
Short-Duration Topical Treatment with Terbinafine
- A dose-ranging clinical trial found that terbinafine emulsion gel applied once daily for 5 days was effective in treating tinea pedis, with efficacy rates of 86% and 68% for 1% and 3% concentrations, respectively 8.
- The study also found that terbinafine 1% emulsion gel was the lowest effective concentration, and was significantly superior to placebo 8.
- Short-duration topical treatment with terbinafine has been shown to be safe and effective, providing a convenient treatment option for patients with tinea pedis 6, 8.