Athlete's foot
What is athlete’s foot?
Athlete’s foot is a rash caused by fungus. It is usually itchy. This fungus is all over the place. You will notice damp, peeling skin between the toes, and dry skin on the bottom and sides of the feet. The skin can also dry out and crack between the toes. These splits are called fissures and are very painful. The fungus can also get into the toenails causing yellow, thickened nails.
Why do I have athlete’s foot?
Athlete’s foot is usually picked up in communal showers or baths (at pools or in dorms) - I got it my first year in college. Tight-fitting shoes or shoes that don’t “breathe” combined with high humidity or sweaty feet also increase your chances of getting athlete’s foot.
How do I fix athlete’s foot?
When you have athlete’s foot, there are several things to try to make it better. None of these are perfect, but hopefully, you can find the best combination for your feet:
Apply a thin layer of topical antifungal cream twice a day. Head-to-head studies don’t exist on the best antifungal creams, but antifungals ending in “-afine” appear to work better (and are pricier) than antifungals ending in “-azole.” I would try a cheaper “azole” first.
“-afine” antifungals (more expensive): butenafine or terbinafine.
“-azole” antifungals (less expensive): miconazole or clotrimazole.
NOTE: The percentages of each medicine are only important for that specific medicine, so ketoconazole 2% (prescription) is twice as strong as ketoconazole 1% (over-the-counter), but miconazole 2% is NOT stronger than clotrimazole 1%.
If it’s itchy, use steroid (cortisone) ointments WITH the antifungal cream
Don’t use steroid ointments alone for athlete’s foot. Fungus loves steroid medicine, and the athlete’s foot will get worse. But, antifungal creams take a couple of weeks by themselves to help with the itchiness of athlete’s foot.
An over-the-counter hydrocortisone ointment works best (instead of cream). Apply a thin layer of hydrocortisone ointment twice daily after putting on the antifungal cream. You would stop the steroid ointment if it is not itchy anymore.
WARNING: Overuse of topical steroids like hydrocortisone can cause skin thinning, stretch marks, and easy bleeding or bruising.
If your feet sweat or it is humid where you live, use a foot powder with antifungal in it.
Foot powders help keep the skin dry. I like ones with an antifungal medication (brand name or generic) in them to help clear the skin quicker.
Try vinegar soaks to speed up the process.
Vinegar soaks are immensely helpful for cleaning up superficial infections with fungus or bacteria and healing up any scratched, broken, or damaged skin. Safe for all ages.
For deep cracks (fissures) on the feet, some people use super glue.
After pushing the fissure closed (this often requires an extra pair of hands), put a strip of super glue along the length of the fissure - this helps the skin stay closed long enough to heal together. Liquid bandage also helps (some have lidocaine to numb the pain).
Wear flip-flops as much as possible to keep the feet dry.
Combo creams (antifungal medicine + mild acid to peel off dry skin) make treatment simple - the go-to option is Whitfield’s ointment.
How do I keep athlete’s foot from coming back?
After you clear your athlete’s foot, several things can be done to prevent it from returning:
Clean your feet daily in the shower with mild soap and water.
Dry your feet very well after your shower, especially between the toes.
Apply a thin layer of antifungal cream to your feet and around the edges of your toenails after drying on the weekends.
Wear cotton socks when wearing shoes.
Change your shoes every day (don’t wear the same pair of shoes two days in a row).
Treat shoes with antifungal spray or powder once every other week.
Wear flip-flops in public locker rooms (at gyms) or at public pools.
Avoid pedicures.
What if my athlete’s foot isn’t getting better?
Usually, the steps above can help most people get their athlete’s foot better. If the athlete’s foot is better, but the feet are still dry see my DRY FEET page. Other rashes can look like athlete’s foot (like a bacterial infection or eczema on the feet). If over-the-counter options are not working or if the athlete’s foot keeps coming back, look for a board-certified dermatologist in your area to check them. There are stronger prescription medications that can be given - a course of oral antifungal medications works really well for most people. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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