Understanding the Condition

Athlete’s foot is a contagious fungal infection caused by dermatophytes¹. These organisms damage the skin barrier by breaking down keratin, leading to irritation and visible skin changes.

They thrive in warm, moist environments, such as inside footwear or on communal floors in gyms and changing rooms⁸, making transmission relatively easy through direct contact or contaminated surfaces⁸.

Certain patients may be more susceptible, particularly those with a compromised skin barrier or underlying conditions such as diabetes, obesity or immunodeficiency⁸.

Common Patient Challenges

A key challenge in managing athlete’s foot is that patients may not immediately recognise it. Symptoms are often misinterpreted as eczema or another skin condition, leading to inappropriate self-treatment¹.

Others may delay treatment altogether, assuming the condition will resolve on its own. In these cases, using treatments that do not target the underlying fungus, such as corticosteroids, can provide temporary symptom relief but fail to address the cause¹.

Left untreated, athlete’s foot can worsen or spread to other areas, including the nails, making it more difficult to manage¹.

Treatment Overview

Topical antifungals are the first-line treatment for athlete’s foot, with two main classes used in practice: allylamines and azoles^9,10.

Allylamines, such as terbinafine, work by killing the fungus (fungicidal action). This typically allows for shorter treatment durations, often around one week and is associated with lower rates of relapse and non-adherence^5,11-12.

In contrast, azoles such as clotrimazole and miconazole are fungistatic, meaning they inhibit fungal growth rather than killing it. As a result, they generally require longer treatment courses, which can increase the risk of poor adherence and recurrence⁵, ^11-12. Additionally, azoles may have a greater potential for drug–drug interactions via Cytochrome P450 pathways^13,14.

Adherence and Relapse

One of the biggest barriers to successful treatment is adherence. Patients often begin to feel relief within a few days, which can lead to early discontinuation of treatment⁵.

However, stopping treatment too soon increases the risk of recurrence, as the infection may not be fully eradicated^9-12. Longer treatment regimens further compound this issue, as they are associated with higher rates of non-compliance and ongoing cycles of infection⁵.

Terbinafine: Key Benefits

Terbinafine offers several advantages in the management of athlete’s foot. It has a fungicidal mechanism of action, directly killing dermatophytes¹⁵, and works earlier in the fungal pathway, which contributes to its clinical effectiveness¹⁵.

This can translate into faster clearance of infection and high mycological cure rates, exceeding 92% in studies^16-19. Importantly, terbinafine also forms a reservoir within the skin, remaining active for up to three months after treatment and helping to prevent relapse¹⁶.

Lamisil Portfolio (Terbinafine 1%)

The Lamisil OTC range includes two products designed to address different patient needs and support adherence.

1. Lamisil ONCE

Lamisil ONCE offers a single-application treatment⁷, making it particularly suitable for patients seeking convenience. It is designed to improve adherence and has demonstrated a 78.2% mycological cure rate at 6 weeks, with a film-forming solution⁷ that enhances delivery and prolongs activity within the skin²⁰. Suitable for 18+ years⁷.

How to use:

• Apply once only — a full course of treatment is completed in a single application
• Use on both feet, even if symptoms are visible on just one foot, to ensure complete treatment of any unseen infection
• Apply to clean, dry skin, covering:
  
  • Between the toes
  • The sole
  • The sides of the foot
• Spread the solution evenly across the skin
• Do not massage or rub in
• Allow the solution to dry naturally (1–2 minutes)
• Avoid washing feet for 24 hours after application to allow optimal absorption and effectiveness
• Wash hands after applying to each foot

Need a quick guide?
Click here to watch how to apply Lamisil ONCE. 
Please note: this video shows UK packaging; however, administration is identical.

1. Lamisil AT Cream

Lamisil AT Cream provides an alternative option for patients who prefer a short course of treatment. Applied once daily for 7 days, it has shown a 91.4% mycological cure rate at 7 weeks⁵. Its formulation also includes emollients to help manage dry, cracked skin, making it well-suited to patients with more affected skin areas²¹. Suitable for 16+ years²¹.

The Pharmacist’s Role

Pharmacists play a crucial role in supporting patients with athlete’s foot. This includes helping to identify the condition correctly, ensuring the appropriate antifungal treatment is selected, and reinforcing the importance of completing the full course of therapy.

Providing advice on hygiene and prevention is also key, alongside tailoring recommendations to the individual needs and lifestyle of each patient. This personalised approach can help improve adherence and reduce the likelihood of recurrence.

For more information, please read the full training PDF – found here:

References

1. Ilkit, M. and Durdu, M., 2015. Dermatophytes and dermatophytoses. Critical Reviews in Microbiology.
2. Crawford, F., 2009. Athlete’s foot. BMJ Clinical Evidence.
3. Gupta, A.K. et al., 2004. Tinea pedis: an overview. American Journal of Clinical Dermatology.
4. Urban, K. et al., 2021. The burden of dermatological conditions. JAAD International.
5. Korting, H.C. et al., 2001. Clinical efficacy of antifungal treatments. Medical Mycology.
6. NHS, n.d. Athlete’s foot. Available at: https://www.nhs.uk/conditions/athletes-foot/ (Accessed: 26 May 2026).
7. Lamisil AT Cream SmPC
8. Cleveland Clinic, n.d. Athlete’s foot (tinea pedis). Available at: https://my.clevelandclinic.org/health/diseases/22139-athletes-foot-tinea-pedis (Accessed: 26 May 2026)
9. Hart, R. et al., 1999. Treatment of athlete’s foot. BMJ, 319(7202), pp.79–82.
10. Anonymous, 2002. Getting rid of athlete’s foot. Drug and Therapeutics Bulletin, 40(7), pp.53–54.
11. Finlay, A.Y., 1999. Management of dermatological conditions. BMJ, 319(7202), pp.71–72.
12. Kyle, A.A. and Dahl, M.V., 2004. Dermatophyte infections. American Journal of Clinical Dermatology, 5(6), pp.443–451.
13. Godamudunage, M.P. et al., 2018. Metabolic interactions of antifungal agents. Drug Metabolism and Disposition, 46(9), pp.1329–1337.
14. Vickers, A.E. et al., 1999. Drug metabolism studies. Drug Metabolism and Disposition, 27(9), pp.1029–1038.
15. Ryder, N.S., 1992. Mechanism of action of antifungals. British Journal of Dermatology, 126(Suppl. 39), pp.2–7.
16. Schäfer-Korting, M. et al., 2008. Skin pharmacology of antifungal agents. Skin Pharmacology and Physiology, 21, pp.203–210.
17. Rotta, I. et al., 2013. Efficacy of antifungal treatments. JAMA Dermatology, 149, pp.341–349.
18. Rotta, I. et al., 2012. Comparative effectiveness of antifungals. British Journal of Dermatology, 166, pp.927–933.
19. Weinberg, J.M., 2009. Antifungal treatments overview. Journal of Clinical and Aesthetic Dermatology, 2, pp.38–42.
20. Ortonne, J.P. et al., 2006. Clinical efficacy of terbinafine formulations. Journal of the European Academy of Dermatology and Venereology, 20(10), pp.1307–1313.
21. Lamisil Once 1% Cutaneous Solution SmPC

Lamisil Once 1% cutaneous solution. Each gram of cutaneous solution contains 10 mg terbinafine (as hydrochloride). Indication: Lamisil Once 1% cutaneous solution is indicated in the treatment of tinea pedis (athlete’s foot) for adults. Posology and method of administration: Cutaneous use only. Adults aged 18 years and over: The film forming solution should be applied once on both feet, even if lesions are visible on one foot only. This ensures elimination of the fungi (dermatophytes) that might be found in areas of the feet where no lesions are visible. Clinical symptoms usually start to improve within a few days. If there are no signs of improvement within two weeks after completed treatment, patients should contact a pharmacist to verify that the product is correctly used or see a doctor to verify diagnosis. There is no data on repeated treatment with this product, therefore a second treatment cannot be recommended within a particular episode of tinea pedis. Lamisil Once 1% cutaneous solution has not been studied in the paediatric population. Its use is therefore not recommended in patients below 18 years of age. Method of administration: Apply a thin layer to clean dry feet starting at the toes, to the sole and sides of the foot. Leave to dry for 1-2 minutes. Apply to both feet. Wash hands after each foot application. Treated areas should not be washed for 24 hours. Refer to the SmPC for full practical instructions for use. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions for use: Lamisil Once 1% cutaneous solution should be used with caution in patients with lesions where alcohol could be irritating (after sun exposure or severe skin scaling). It should not be used on the face. Lamisil Once 1% cutaneous solution is for external use only. It may be irritating to the eyes. In case of accidental contact with the eyes, rinse eyes thoroughly with running water. Lamisil Once 1% cutaneous solution should be kept out of the sight and reach of children. Lamisil Once 1% cutaneous solution is not recommended to treat hyperkeratotic chronic plantar tinea pedis (moccasin type). In the event of allergic reaction, the film should be removed with an organic solvent such as denatured alcohol and the feet washed with warm soapy water. Fertility, pregnancy and lactation: There is no clinical data for the use of terbinafine in pregnant women. Animal studies do not indicate any harmful effects with respect to pregnancy or the health of the foetus. Lamisil Once 1% cutaneous solution should not be used during pregnancy unless clearly necessary. Terbinafine is excreted into breast-milk. After topical use, only a low systemic exposure is expected. Terbinafine should only be used in a nursing mother if the expected benefit justifies the risk to the infant. In addition, infants must not be allowed to come into contact with any treated skin, including the breast. No effect of terbinafine on fertility have been seen in animal studies. Undesirable effects: Undesirable effects include mild and transient reactions at the site of application. In very rare instances, allergic reactions may occur. Uncommon (>1/1,000, <1/100): application site reactions such as skin dryness, skin irritation or burning sensation. Very rare (<1/10,000): allergic reactions such as rash, pruritus, dermatitis bullous and urticaria. Not known (cannot be estimated from available data): Skin exfoliation, skin discolouration, erythema, application site pain, eye irritation. Marketing Authorisation Holder: Karo Pharma AB, Box 16184, 103 24, Stockholm, Sweden. Marketing Authorisation Number: PA22650/009/003. Legal Category: P – Supply through pharmacies only. Not subject to medical prescription. For full prescribing information, please refer to the Summary of Product Characteristics: https://www.medicines.ie/medicines/lamisil-once-1-cutaneous-solution-32641/spc. Suspected adverse reactions should be reported to the HPRA Pharmacovigilance, website: www.hpra.ie and directly to adverse PVIE@karopharma.com. Date of preparation: May 2026.

Lamisil AT Cream. Terbinafine hydrochloride 1% w/w; each gram contains 40 mg stearyl alcohol, 40 mg cetyl alcohol and 10 mg benzyl alcohol. Pharmaceutical form: White smooth or almost smooth glossy cream. Indication: Lamisil AT Cream is indicated for the treatment of tinea pedis (athlete’s foot) and tinea cruris (jock itch) caused by dermatophytes including Trichophyton spp. and Epidermophyton floccosum. Posology and method of administration: Cutaneous use only. For adults and adolescents over16 years, apply once daily for 1 week; clean and dry the affected area before application and apply a thin layer to affected and surrounding skin, rubbing in lightly; intertriginous infected areas may be covered with gauze if required; relief usually occurs within a few days but if no improvement after 2 weeks, diagnosis should be reviewed. The experience with topical Lamisil AT Cream in children is still limited and its use in children under 16 years cannot therefore be recommended. Contraindications: Hypersensitivity to terbinafine or any of its excipients. Warnings and precautions: For external use only; do not use on the face; avoid contact with eyes; may irritate eyes; use with caution on alcohol-sensitive lesions. Contains cetyl and stearyl alcohol (may cause local skin reactions) and 10 mg/g benzyl alcohol (may cause mild irritation). Fertility, pregnancy and lactation: Do not use in pregnancy unless clearly necessary; must not be used during breast-feeding as terbinafine is excreted in breast milk; no evidence of effects on fertility in animal studies. Undesirable effects: Common: skin exfoliation, pruritus; Uncommon: skin lesion, scab, skin disorder, pigmentation disorder, erythema, skin burning sensation, pain, application site pain or irritation; Rare: dry skin, contact dermatitis, eczema, eye irritation, condition aggravated; Not known: rash, hypersensitivity reactions which may require discontinuation. Marketing authorisation holder: Karo Pharma AB, Box 16184, 103 24, Stockholm, Sweden. Marketing authorisation number: PA22650/009/002. Legal category: P – Supply through pharmacies only. Not subject to medical prescription. For full prescribing information, please refer to the Summary of Product Characteristics: https://www.medicines.ie/medicines/lamisil-at-cream-32640/spc#tabs Suspected adverse reactions should be reported to the HPRA Pharmacovigilance, website: www.hpra.ie and directly to PVIE@karopharma.com. Date of preparation: May 2026.