Signs You Need Prescription Medication for Athlete's Foot

When over-the-counter remedies aren't enough

Often, using an over-the-counter (OTC) athlete's foot treatment is enough to clear up a case of athlete's foot (tinea pedis). But if, after a few weeks, the skin between your toes is still peeling, itching, and starting to swell and blister, you may need to see a healthcare provider for a prescription athlete's foot medication.

This article will explain when you might need a prescription treatment for athlete's foot. It will also discuss various treatment options and their possible side effects.

Woman applying foot cream
PhotoAlto / Odilon Dimier / Getty Images

Signs You Need a Prescription

Generally speaking, prescription medications are needed to treat athlete's foot if:

  • The infection hasn't cleared after four weeks of self-treatment.
  • The infection goes away but comes back (recurs).
  • The infection is spreading to other parts of the body (such as the nails, groin, or hands).

If you have athlete's foot and diabetes, you should see your healthcare provider right away; don't bother with home treatment. Athlete's foot can cause dry, cracked skin, which can leave people with diabetes vulnerable to serious complications such as cellulitis, bacterial infections, or skin ulcers.

When to Call a Healthcare Provider

Call your healthcare provider immediately or seek urgent care if:

  • Your foot is swollen and developing red streaks.
  • There is discharge containing pus or other fluids.
  • You develop a high fever and other signs of infection.

Treatment Options

If your athlete's foot fails to respond to over-the-counter medications, your healthcare provider will usually a prescribe prescription-strength version of the same topical medications. These include:

  • Lamisil (terbinafine)
  • Spectazole (econazole)
  • Mentax (butenafine)
  • Lotrimin (clotrimazole)
  • Micatin (miconazole)
  • Naftin (naftifine)
  • Luzu (luliconazole)
  • Ertaczo (sertaconazole)
  • Exelderm (sulconazole)
  • Tinactin (tolnaftate)

Treatment is usually continued for four weeks or at least one week after all of the skin symptoms have cleared.

If the fungus is resistant to topical treatment, oral antifungals—like Lamisil (terbinafine), Sporanox (itraconazole), and Diflucan (fluconazole)—may be prescribed. Oral antifungals may be prescribed for anywhere from one to nine weeks depending on the severity of the infection.

Other Medications

If a secondary infection has developed (usually when bacteria enter through open breaks in the skin), an oral antibiotic may be prescribed. These include Augmentin (amoxicillin-clavulanate), cephalexin, dicloxacillin, and clindamycin.

While topical corticosteroids may be useful in treating non-infectious foot conditions, like eczema or psoriasis, they can aggravate athlete's foot fungus by suppressing the immune system and should be avoided.

The longer your athlete's foot lasts, the greater the chance it will spread to your toenails or fingernails. This can result in a difficult-to-treat infection that leaves your nails thick, discolored, and crumbly. If this occurs, a six- to 12-week course of oral antifungals, along with medicated creams and Penlac (ciclopirox) nail polish may be needed.

Oral Antifungal Side Effects 

While oral antifungals can be effective in resolving treatment-resistant athlete's foot, they carry a greater risk of side effects than their topical counterparts.

Lamisil

Lamisil can cause headaches, nausea, vomiting, diarrhea, gas, nausea, upset stomach, stuffy nose, cough, dizziness, and an unpleasant taste in the mouth. Long-term use can damage the liver. Caution needs to be taken when using oral Lamisil in people with liver disease.

Sporanox

Sporanox may cause many of the same symptoms as Lamisil, along with constipation and joint pain. You should not take oral Sporanox if you have congestive heart failure.

Let your healthcare provider know if you have cardiovascular disease, a breathing disorder, cystic fibrosis, long QT syndrome, liver or kidney disease, or a family history of any of these disorders.

Diflucan

Diflucan may cause headaches, diarrhea, nausea, upset stomach, vomiting, and changes in taste. It should be used with caution in people with long QT syndrome, heart rhythm disorders, liver disease, or kidney disease.

Precautions in Pregnancy

If you are pregnant or nursing, discuss your treatment options with your healthcare provider so that you can make a fully informed choice. This is especially true in the first trimester during the early stages of fetal development.

Research has shown that higher doses of oral antifungal drugs may cause harm to the fetus and should be avoided. The risk is higher with Diflucan but also applies to other commonly prescribed oral antifungals.

In most cases, a combination of topical antifungals and home care will provide relief. Topical drugs can be used throughout the pregnancy because only a small amount is absorbed through the skin.

Preventing Athlete's Foot

People commonly get athlete's foot from walking barefoot in moist public areas, such as locker rooms or swimming pool decks. To reduce your chances of getting athlete's foot, try wearing flip flops, shower shoes, or sandals in such areas.

Also, it's important to generally keep your feet, socks, and shoes dry. Fungus grows more easily in warm and moist areas, like in sweaty shoes. Be sure to wash your feet each day with soap and dry them thoroughly after washing.

Summary

Athlete's foot, or tinea pedis, is a common fungal infection that affects the foot. Mild cases of athlete's foot can usually be treated with over-the-counter ointments, but severe or persistent cases may require prescription medications like Lamisil (terbinafine) and Spectazole (econazole).

A Word From Verywell

If you are dealing with a stubborn case of athlete's foot, talk with your doctor about prescription options and remember to advise them about any medical conditions you have or any drugs you may be taking (including vitamins, herbal remedies, and nutritional supplements).

Frequently Asked Questions

  • Why is my athlete’s foot not responding to any treatment?

    You may not have athlete’s foot. Eczema, dry skin, and other conditions are similar to athlete’s foot but require different treatments. See your healthcare provider to get the right diagnosis. If it is athlete’s foot, you may need a stronger antifungal cream or an oral medication.

  • What is the best prescription medicine for athlete’s foot?

    There's no clear-cut best prescription medicine for athlete's foot, but common prescriptions known to be successful in treating the condition include Lamisil (terbinafine), Sporanox (itraconazole), and Diflucan (fluconazole).

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