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Health condition · Clinically reviewed

Athlete’s foot, four patterns, one stepped plan.

A very common dermatophyte infection - interdigital, moccasin, vesiculobullous and ulcerative. Topical terbinafine first, oral antifungals where needed.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CKS, BAD and peer-reviewed dermatology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including topical terbinafine first-line and oral options for extensive disease.

Key facts

Athlete’s foot at a glance.

The essentials, in plain English - what it is, the patterns, and how it is treated in the UK today.

  • What it is

    A dermatophyte fungal infection of the foot - most often Trichophyton rubrum, with T. interdigitale and Epidermophyton floccosum also implicated.

  • How common

    Very common - up to 15 per cent of UK adults are affected at some point, more in athletes and communal-shower users.

  • Four patterns

    Interdigital (most common), moccasin (chronic hyperkeratotic), vesiculobullous and ulcerative - each looks different and matters clinically.

  • First-line therapy

    Topical terbinafine 1 per cent for one to two weeks - the best-evidenced and shortest topical course.

  • Oral option

    Oral terbinafine or itraconazole for extensive, refractory, moccasin or immunocompromised disease - often paired with nail treatment.

  • It can spread

    To toenails (onychomycosis), hands (tinea manuum - classic two feet, one hand) and groin (tinea cruris) if left untreated.

Why this guide matters

A stepped plan, not endless creams.

Athlete’s foot is common, treatable and often preventable. Three points shape everything else on this page.

  • Topical terbinafine is first-line

    One to two weeks of 1 per cent cream, spray or gel - the shortest evidence-based course for classic interdigital disease.

  • Pattern matters

    Moccasin and vesiculobullous patterns often need longer courses or oral therapy - one week of cream is not enough.

  • Treat the nails and the shoes

    Untreated onychomycosis and damp, unrotated footwear are why athlete’s foot keeps coming back.

How the diagnosis is made

From itchy toes to a clear plan.

The steps a UK GP, pharmacist or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused clinical exam

    Look at the toe webs, sole, heel and instep for the pattern - interdigital maceration, moccasin scaling, vesicles or ulceration.

  2. 02

    Assessing

    Ask about risk factors

    Communal showers, pools, gyms, occlusive footwear, hyperhidrosis, diabetes and immunocompromise all raise the odds.

  3. 03

    Assessing

    Check nails and other sites

    Look for concurrent onychomycosis, tinea manuum (usually one hand) and tinea cruris - these change the treatment plan.

  4. 04

    Confirming

    Skin scraping and KOH

    Reserved for diagnostic uncertainty, refractory, widespread or hyperkeratotic disease, or immunocompromised patients.

  5. 05

    Confirming

    Fungal culture

    Speciates the organism when microscopy is equivocal or oral therapy is planned - a Woods lamp is rarely helpful for dermatophytes.

  6. 06

    Preparing

    Baseline bloods if oral therapy

    LFTs before starting oral terbinafine or itraconazole, with monitoring for longer courses.

  7. 07

    Preparing

    Plan for the nails

    If toenails are involved, discuss combined topical, oral or laser options - see our nail fungus laser guide.

Typical timeline: first pharmacy visit to a settled plan in days, not weeks.

Symptoms

What athlete’s foot actually looks like.

Four clinical patterns, plus the features that mean it is time to escalate to oral therapy or specialist review.

  • Interdigital maceration

    Moist, white, peeling skin and fissuring between the 3rd/4th and 4th/5th toe webs - the classic starting point.

  • Moccasin scaling

    Chronic fine scaling and hyperkeratosis of the sole, heel and lateral foot in a slipper-like distribution, often bilateral.

  • Vesicles and bullae

    Sudden crops of small blisters and bullae on the instep with erythema - the vesiculobullous pattern.

  • Ulceration and secondary infection

    Painful ulcers with bacterial superinfection - more likely in diabetes and immunosuppression.

  • Itch, burn and smell

    Itching, burning and an unpleasant odour are the everyday complaints that bring people to the pharmacy.

  • Spread to nails

    Thick, discoloured, crumbly toenails - onychomycosis often coexists and can reinfect the skin.

  • Two feet, one hand

    A classic pattern - tinea pedis on both feet with tinea manuum on the dominant hand from scratching.

  • Red flag - diabetic foot

    Fissuring, ulceration or cellulitis on a diabetic foot needs same-day review to prevent limb-threatening infection.

Treatment

How athlete’s foot is treated in the UK.

Topical terbinafine first, imidazoles as a solid alternative, oral antifungals for extensive or refractory disease and hygiene to keep it away.

  • Topical terbinafine

    One per cent cream, spray or gel for one to two weeks - the best-evidenced and shortest topical course for interdigital disease.

  • Topical imidazoles

    Clotrimazole, miconazole or econazole for two to four weeks - effective alternatives, useful in pregnancy.

  • Undecenoic acid

    An over-the-counter option for mild interdigital disease - slower to work than terbinafine but well tolerated.

  • Oral terbinafine

    250 mg once daily for two weeks (longer for extensive or moccasin disease) - first-line oral option with LFT monitoring.

  • Oral itraconazole

    200 mg twice daily for a one-week pulse - useful when terbinafine is not tolerated or contraindicated.

  • Oral fluconazole

    A weekly-dosed alternative for selected patients - review interactions and LFTs before starting.

  • Hyperhidrosis treatment

    Aluminium chloride antiperspirant, iontophoresis or botulinum toxin for severe sweating that keeps driving reinfection.

  • Prevention and hygiene

    Dry between the toes, rotate shoes 24 to 48 hours, flip-flops in communal areas, wash socks at 60 degrees and treat any nail involvement.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, pharmacist or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Fungal skin infection - foot.

  • British Association of Dermatologists (BAD). Tinea pedis patient information leaflet.

  • BNF. Antifungals - terbinafine, itraconazole, fluconazole prescribing and monitoring.

  • European Academy of Dermatology and Venereology. Guidance on superficial mycoses.

Red flags

When athlete’s foot needs urgent attention.

Most cases are manageable in primary care or the pharmacy. These are the situations that are not.

  • Diabetic foot with fissuring

    Any break in the skin on a diabetic foot can seed cellulitis or a deeper infection - same-day review is safer than watch-and-wait.

  • Rapidly spreading redness

    Warm, tender, spreading erythema up the foot or leg suggests secondary bacterial cellulitis - needs urgent antibiotics.

  • Immunocompromise

    Chemotherapy, biologics, transplant or HIV - low threshold for oral antifungals and specialist review.

  • Ulceration or non-healing lesion

    Deeper ulcers, especially with pain out of proportion, need review to exclude deep tissue infection.

  • Failure to respond at 4 weeks

    Refractory or worsening disease despite adequate topical therapy warrants scraping, culture and often oral treatment.

  • Recurrent infection

    Frequent relapses point to untreated onychomycosis, hyperhidrosis or reinfection from footwear that needs addressing.

  • Systemic symptoms

    Fever, malaise or lymphangitis alongside foot infection needs urgent GP or same-day service review.

  • Vesiculobullous flare

    A sudden blistering flare can mimic pompholyx eczema and sometimes needs a short course of oral therapy.

  • Concern for another diagnosis

    Well-demarcated plaques (psoriasis), coral-red fluorescence (erythrasma) or beefy red satellite pustules (candida) point elsewhere.

Living with it

A treatable condition, with clear habits.

Four things that make the biggest difference day to day - drying between the toes, rotating shoes, flip-flops in communal areas and finishing the course.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for the full course do more than a heroic week that stops early.

  1. 01 Dry

    Dry between the toes

    Ten seconds with the corner of a towel after every shower - moisture is what the fungus needs to live.

  2. 02 Rotate

    Rotate your shoes

    Give each pair 24 to 48 hours to dry out - alternating footwear is one of the simplest ways to stop reinfection.

  3. 03 Protect

    Flip-flops in communal areas

    Pools, gym showers and hotel bathrooms are the classic reinfection sites - a cheap pair of flip-flops does a lot.

  4. 04 Finish

    Complete the full course

    Keep applying the antifungal for the full one to two weeks even after the skin looks better - stopping early is why it comes back.

Frequently asked

Everything we get asked about athlete’s foot.

Quick answers on creams, tablets, prevention and why it keeps coming back.

  • What is athlete’s foot?

    A dermatophyte fungal infection of the foot, most commonly caused by Trichophyton rubrum. It ranges from mild scaling between the toes to widespread moccasin-pattern involvement of the sole, and can spread to the nails, hands and groin.

  • How do I know it is athlete’s foot and not eczema or psoriasis?

    Athlete’s foot tends to start between the toes with maceration and peeling, whereas eczema is often symmetrical and itchy, psoriasis has well-demarcated plaques and pitted keratolysis produces tiny pits and an odour. If it is unclear, a skin scraping for microscopy and culture will settle it.

  • Which cream works best?

    Topical terbinafine 1 per cent has the best evidence and the shortest course - usually one to two weeks. Imidazoles such as clotrimazole or miconazole are effective alternatives but need two to four weeks of treatment.

  • When do I need tablets?

    Oral antifungals are reserved for extensive, refractory or moccasin-pattern disease, immunocompromised patients and anyone with concurrent nail infection. Oral terbinafine for two weeks is the usual first-line choice.

  • Why does it keep coming back?

    Untreated toenail infection, undiagnosed hyperhidrosis, occlusive footwear and reinfection from communal areas are the main culprits. Rotate shoes, dry carefully between the toes, wash socks at 60 degrees and treat any nail involvement.

  • Is athlete’s foot contagious?

    Yes - it spreads through contact with infected skin scales on floors, towels and shoes. Avoid sharing towels or footwear, wear flip-flops in communal showers and treat all four patterns promptly to protect the people you live with.

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