Athlete's Foot Treatments Compared
Terbinafine in a fortnight against imidazoles in a month, the seven days that decide recurrence, and why a steroid cream on its own makes it worse.
Part of the Complete Athlete's Foot Guide.
Key fact: Keep applying for about 7 days after the skin looks normal. Fungus remains in the outer layer well after the appearance settles, and stopping at the point it looks better is the single commonest reason athlete's foot returns a fortnight later.
The options
| Treatment | How it works | Course |
|---|---|---|
| Terbinafine 1% cream | Fungicidal — kills the fungus | Thinly once or twice daily for 1 to 2 weeks |
| Clotrimazole 1%, miconazole 2%, ketoconazole 2% | Fungistatic — stops it multiplying while the skin renews | At least 4 weeks, continuing after clearing |
| Undecenoate preparations | Weaker antifungal action | 4 to 6 weeks, plus 7 days after healing |
| Antifungal powders and sprays | Useful for shoes and for keeping skin dry | Alongside a cream, not instead of it |
| Oral terbinafine | Systemic — for extensive or resistant infection | Usually 2 to 4 weeks, on prescription |
The practical difference is the course length. Terbinafine finishes in a fortnight; an imidazole needs a month of daily application, which is considerably more likely to be abandoned halfway.
Terbinafine
- Apply thinly once or twice daily — more cream does not work faster
- 1 to 2 weeks for athlete's foot, which is shorter than most people expect
- Cover a margin of about 2cm of normal-looking skin beyond the visible edge
- Include every toe web, not only the obviously affected one
- Treat the whole sole if the scaly moccasin pattern is present
- Usually for those over 12 — check the pack, and ask about younger children
It keeps working in the skin for a period after the last application, which is part of why the course is short. That is not a reason to stop early — the seven-days-after rule still applies.
Clotrimazole, miconazole and ketoconazole
These stop the fungus multiplying rather than killing it outright, so the skin has to renew itself while the infection is held in check. That takes longer.
- At least 4 weeks, typically twice daily
- Continue after the skin clears — this matters even more than with terbinafine
- Widely available and inexpensive
- The commonest reason they fail is duration, not the medicine
When a steroid is added
Where the skin is markedly inflamed, sore and itchy, a short course of hydrocortisone 1% can be used alongside the antifungal — once daily, for a maximum of 7 days, on advice.
Never use a steroid cream on its own for a fungal rash. It damps the inflammation, so the rash looks better for a few days while the fungus spreads unchecked and loses its typical appearance. The result — steroid-modified tinea, or tinea incognito — is more extensive, harder to recognise, and worse than it started. This is one of the commonest self-treatment mistakes in skin problems, because a steroid cream is what most households already have.
Applying it properly
| Step | Why |
|---|---|
| Wash and dry the feet thoroughly first | Particularly between the toes. Cream on wet macerated skin does little |
| Dab dry rather than rubbing | Rubbing damages already fragile skin and spreads fungus |
| Apply to every toe web | Fungus is present beyond where it is visible |
| Extend a margin beyond the rash | The edge is where the fungus is most active |
| Wash hands afterwards | Hand involvement usually comes from treating the feet and scratching |
| Keep going 7 days past clearing | The rule that decides recurrence |
If the skin between the toes is very soggy, keeping it dry matters as much as the cream — a wisp of dry cotton wool between the toes, or simply separating them while the feet air, makes a real difference.
Shoes, socks and the second reservoir
- Do not wear the same shoes more than 2 to 3 days in a row — each pair needs time to dry out completely
- Antifungal powder or spray inside shoes, which is the only thing that treats the footwear itself
- Clean cotton socks daily, washed hot
- Consider replacing a pair of trainers worn constantly throughout a long infection
- Flip-flops in communal showers and changing rooms, both ways
- A separate towel for the feet, and dry the feet last
When tablets are needed
- Extensive infection, or infection that has not cleared with an adequate topical course
- The moccasin pattern covering the whole sole, which penetrates the thick skin poorly
- Nails involved as well, which topical foot treatment does not reach
- Usually oral terbinafine for 2 to 4 weeks, after assessment, with the same monitoring considerations as for nail treatment
If the nails are involved
Cream does not penetrate a nail plate. If the toenails are thickened, discoloured or crumbling, treating the skin alone will clear it temporarily and then fail, because the nail keeps shedding fungus onto the skin.
Nail treatment is a different and much longer course — see fungal nail treatments compared and the fungal nail infection guide. The reinfection loop between skin and nail is covered there in full.
If it is not working
| Possibility | What to do |
|---|---|
| Course too short | 4 weeks for an imidazole, and 7 days past clearing for anything. The commonest reason |
| It is not fungal | See is it athlete's foot? — dyshidrotic eczema and contact dermatitis both mimic it |
| A steroid cream was used | The rash may be steroid-modified and considerably more extensive than it appears |
| Nails untreated | The skin will keep being reinfected |
| Feet staying damp, shoes untreated | Address both, or treatment is a holding action |
| Secondary bacterial infection | Smelly, macerated, weeping skin may need more than an antifungal |
| Spreading redness up the foot or leg | Get seen promptly — possible cellulitis |
Frequently Asked Questions
How long should you use athlete's foot cream?
Terbinafine 1% cream is used for 1 to 2 weeks; clotrimazole, miconazole and similar imidazoles need at least 4 weeks. Whichever you use, continue for about 7 days after the skin looks normal, because fungus remains in the outer layer after the appearance settles.
What is the difference between terbinafine and clotrimazole?
Terbinafine kills the fungus, so the course is short, typically 1 to 2 weeks. Clotrimazole and other imidazoles stop it multiplying while the skin renews itself, which takes at least 4 weeks. Both work; the difference in practice is that a four-week course is much more likely to be abandoned halfway.
Can I use hydrocortisone on athlete's foot?
Only alongside an antifungal, once daily for a maximum of 7 days, and on advice. Never use a steroid cream alone on a fungal rash: it damps the inflammation so the rash looks better while the fungus spreads unchecked and loses its typical appearance, producing a more extensive and harder-to-recognise infection.
Do I need to treat my shoes?
Footwear is a genuine reservoir. Do not wear the same shoes more than 2 to 3 days in a row so each pair dries out fully, use an antifungal powder or spray inside them, wear clean cotton socks daily, and consider replacing trainers worn constantly through a long infection.
Why has my athlete's foot come back after treatment?
Most often the course was stopped as soon as the skin looked better. Other common reasons are untreated fungal toenails shedding fungus back onto the skin, shoes that were never dealt with, feet that stay damp, and reinfection from communal floors.
References
- NHS. Athlete's foot. nhs.uk
- NHS. Ringworm and other fungal infections. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Fungal skin infection — foot. cks.nice.org.uk
- Nottinghamshire Area Prescribing Committee. Dermatophyte infection of the skin. nottsapc.nhs.uk
- DermNet. Tinea corporis and tinea incognito. dermnetnz.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. A steroid cream applied to a fungal rash makes it spread while looking better, so a rash that is not clearly diagnosed should be assessed rather than treated with whatever is in the cupboard. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.