Prescription Products For Athlete's Foot

RTT asked

I'm looking for some kind of cream that would be available as a prescription for severe athlete's foot fungus. I am also trying to help with the pain and severely dry, cracked feet that bleed.

Answer

There are a variety of prescription antifungal medications that can be used to treat athlete's foot, but, in most cases, OTC (over the counter) options should be considered first.

OTC antifungals are generally as effective as prescription ones and are significantly less expensive.

For one example, OTC Lotrimin Ultra, which contains the antifungal agent butenafine, costs around $20-30, while prescription options are generally well over $100 (and may not be covered by insurance).

In terms of treating some of the symptoms of athlete's foot (itching, inflammation, cracking), there is a prescription combination antifungal/steroid product (Lotrisone) which may help.

However, Lotrisone is commonly recommended as a second-line treatment only.

This is because the symptoms of athlete's foot often clear up with just antifungal therapy and steroids (like betamethasone) can weaken our immune response to fungal infections, increasing treatment time.

For treatment-resistant infections, some prescription products may be more effective than their over the counter counterparts. Specifically, when fungus extensively spreads between toes, a product like Naftin may have better cure rates.

When all else fails, oral antifungals may need to be used, but these are generally only a last line therapy since they are associated with more side effects (like an increase in liver enzymes).

Since you asked about prescription products for athlete's foot, I list those in the next section.

Prescription Athlete's Foot Products

Prescription athlete's foot products include:

• Clotrimazole
• Oxistat (Oxiconazole)
• Econazole
• Ertaczo (Sertaconazole)
• Luzu (Luliconazole)
• Naftin (Naftifine)
• Mentax (Butenafine)
• Penlac (Ciclopirox)

Two prescription products are also available over the counter (clotrimazole and butenafine).

In addition to these single ingredient products, there is also a prescription 'combination' product, which contains a steroid:

• Lotrisone (Clotrimazole/Betamethasone)

You may notice a similarity in many of the drug names above.

Names that end in "-azole" are classified as imidazoles. Names that end in "-fine" are classified as allylamines. Penlac (ciclopirox) is in a class of its own.

Which Are Better?

As a general rule of thumb "-fine" antifungals work faster than "-azole" antifungals because "-fine" antifungals are fungicidal, meaning they directly kill the fungus.^[1]

Imidazole antifungals (those that end in "-azole") are fungistatic, meaning they stop the replication of the fungus, but don't directly kill it. Treatment duration is generally longer with these antifungals.^[2]

Allylamine antifungals (those that end in "-fine"), in general, take about 1 to 2 weeks of continuous use for successful treatment while imidazole antifungals often take longer, between 2 to 4 weeks.

A shorter treatment duration, while certainly more convenient, doesn't necessarily mean allylamine antifungals are 'better'. They all have similar cure rates regardless of how long they need to be used.

If you try an over the counter topical antifungal and it doesn't work, your next step would likely be to try a prescription antifungal, ideally from a different antifungal class.

It is important to remember that antifungals should be continued to be used for at least one week after your infection looks visually cleared to reduce the risk of recurrence.^[3]

Treating Symptoms

The symptoms associated with athlete's foot tend to go away as you treat it with an antifungal.

However, if symptoms are particularly severe, it may help to use Lotrisone, which contains the steroid betamethasone. This isn't often used as a first-line therapy though since steroids can reduce our bodies ability to fight an infection, and may increase the treatment time needed.^[4]

You can certainly use other, non-steroid products to help with some of the symptoms you are experiencing. One such example is Sarna Sensitive (pramoxine), which should greatly reduce itching.^[5]

Severe Athlete's Foot

The guidelines for the treatment of fungal infections, published in "American Family Physician, don't recommend one product over the other. They do however recommended generic topical antifungals as first-line therapy due to their cost and effectiveness.^[6]

In general, if you don't see any improvement in your condition within four weeks of your first drug therapy, your treatment plan may need to be changed.

For certain cases, oral antifungals may be needed. From the guidelines: