From the Guidelines
Terbinafine 1% cream applied daily for 1 week is the most effective treatment for ringworm tinea pedis, with a mycological cure rate of approximately 94%. This treatment option is supported by a study published in Pediatrics in 2017 1. The study found that terbinafine 1% cream was effective in treating T cruris, and it is likely that it would also be effective in treating tinea pedis.
Treatment Options
- Terbinafine 1% cream applied daily for 1 week
- Butenafine applied twice daily for 2 weeks (only approved for adults)
- Clotrimazole applied twice weekly for 4 weeks
- Oral itraconazole (100 mg daily for 2 weeks or 200 mg daily for 1 week) for more severe cases
Prevention Measures
- Keep feet clean and dry
- Wear breathable footwear
- Change socks daily
- Avoid walking barefoot in public areas It is essential to continue treatment for the full recommended duration, even if symptoms improve earlier, to ensure complete eradication of the fungus and prevent recurrence. While butenafine and clotrimazole are also effective, terbinafine 1% cream is the most effective treatment option, with a high mycological cure rate, as reported in the study 1.
From the FDA Drug Label
Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions INDICATIONS AND USAGE Naftin® Gel, 1% is indicated for the topical treatment of tinea pedis, tinea cruris and tinea corporis caused by the organisms Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans1 and Epidermophyton floccosum.1 For the treatment of ringworm (tinea pedis), terbinafine (TOP) and naftifine (TOP) can be used.
- Terbinafine (TOP): apply twice a day (morning and night) for 1 week on the toes or 2 weeks on the bottom or sides of the foot, or as directed by a doctor 2.
- Naftifine (TOP): is indicated for the topical treatment of tinea pedis caused by certain organisms 3. Key points:
- Wash the affected skin with soap and water and dry completely before applying.
- Wear well-fitting, ventilated shoes and change shoes and socks at least once daily.
- Wash hands after each use.
From the Research
Treatment Options for Tinea Pedis
- Topical antifungal therapy is generally successful for superficial or localized tinea pedis, with treatment duration ranging from 1-6 weeks 4
- Oral antifungal therapy may be necessary for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis, or in immunocompromised patients 4
- Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate, and amorolfine 4
- Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole, and fluconazole 5, 4, 6
Comparison of Treatment Effectiveness
- A study comparing terbinafine and clotrimazole found that terbinafine was more effective in treating tinea pedis, with a mycological cure rate of 93.5% compared to 73.1% for clotrimazole at week 4 7
- Another study found that terbinafine was more effective than griseofulvin, with a pooled risk ratio of 2.26 in favor of terbinafine's ability to cure infection 6
- Terbinafine and itraconazole were also found to be effective compared to placebo, with risk ratios of 24.54 and 6.67, respectively 6
Treatment Duration and Regimen
- Tinea pedis can be effectively treated with pulse doses of 150 mg fluconazole once weekly, with 100 mg itraconazole daily for 2 weeks or 400 mg daily for 1 week, and with 250 mg terbinafine daily for 2 weeks 5
- Treatment should continue for at least one week after clinical clearing of infection 8
- A one-week course of terbinafine 1% cream was found to be more effective than a four-week course of clotrimazole 1% cream in treating tinea pedis 7