Treatment of tinea pedis

Tinea confined to the toe webs:

• topical creams such as an azole cream (e.g. miconazole cream used twice daily for four weeks) may be used. However evidence suggests that topical 1% terbinafine cream used for one week is the most effective topical antifungal available in the UK (1)
• improved foot hygiene and drying between the toes (2)
• if the tissue is inflamed then antifungal / topical steroid combinations may reduce symptoms more rapidly. However they have no overall benefit (3)

Systemic therapy and confirmation of diagnosis is appropriate for

• more complex and multi-site infections (Moccasin pattern tinea).
• associate toe nail infection (4)

The newer antifungals - oral imidazole or triazole antifungals (e.g. - itraconazole) and oral terbinafine are used more commonly than griseofulvin because they have a broader spectrum of activity and require a shorter duration of treatment (4)

• for example itraconazole 200mg bd for 7 days or 100mg od for 30 days

Patients should avoid walking barefoot in communal places (5).

Reference:

• (1) Drugs and Therapeutics Bulletin (2002), 40 (7),53-4.
• (2) De Berker D. Fungal nail disease. NEJM 2009; 360:2108-2116
• (3) Prescriber (2000), 11 (7), 59-73.
• (4) Smith AG. Commentary on: Athlete;s foot: when all else fails” by William C.R. Agunwa [foot ankle surg. 12(2006) 209-210]. Foot ankle surg. 2008;14(1):53-54
• (5) Hainer BL. Dermatophyte infections. AFP 2003;67(1)