TX:
Topical antifungal treatment is the treatment of choice for most patients.
Systemic antifungal treatment should be reserved for patients who fail topical therapy.
Topical drugs effective for tinea pedis include azoles, allylamines, butenafine, ciclopirox, tolnaftate.
Treatment length = 4 weeks.
- Azoles (choose any topical azole)
- Allylamines (choose any topical allylamine) – Terbinafine 1% topical cream. Apply to the area once to twice daily x 4 weeks.
- Butenafine 1% cream. Apply topically twice daily.
- Ciclopirox cream / powder /suspension/ gel / solution/shampoo. Apply topically twice daily. Gently massage into affected areas and surrounding skin; if no improvement after 4 weeks of treatment, re-evaluate the diagnosis.
*** Some studies show that terbinafine is more effective than the azoles.
“Do not use nystatin to treat any tinea infection because dermatophytes are resistant to nystatin. (However, nystatin is often effective for cutaneous Candida infections.)
Do not use oral ketoconazole to treat any tinea infection because of the U.S. FDA boxed warnings about hepatic toxicity and the availability of safer agents.
Do not use combination products such as betamethasone/clotrimazole because they can aggravate fungal infections.” AAFP 2014
Butenafine = Lotrimin Ultra.
Reference
Am Fam Physician. 2014 Nov 15;90(10):702-711. http://www.aafp.org/afp/2014/1115/p702.html