Athlete's foot: treatment, symptoms, causes and prevention

The NHS says athlete's foot is unlikely to get better on its own, but you can buy antifungal medicines for it from a pharmacy. They usually take a few weeks to work and come as creams, sprays and powders. They are not all suitable for everyone, for example some are only for adults, so always check the packet or ask a pharmacist, and you might need to try a few treatments to find one that works best for you.

NICE Clinical Knowledge Summaries (CKS) says initial management should include self-care advice and a topical antifungal cream such as terbinafine, an imidazole, undecenoic acid or topical preparations containing tolnaftate for mild, non-extensive disease in children and adults. It says a short-term mildly potent topical corticosteroid such as hydrocortisone cream can be added if there is marked inflammation, and that fungal nail, hand or groin infection should be managed too, to reduce the risk of reinfection.

If pharmacy treatment has not worked, the NHS says a GP may send a small scraping of skin to a laboratory to check you have athlete's foot, prescribe a steroid cream to use alongside antifungal cream, prescribe antifungal tablets (which you might need to take for several weeks), or refer you to a skin specialist. NICE CKS says an oral antifungal such as terbinafine can be considered first-line if an adult has severe or extensive disease, with itraconazole or griseofulvin as alternatives if terbinafine is not tolerated.

The NHS says one of the main symptoms of athlete's foot is itchy white patches between your toes. It can also cause sore and flaky patches on your feet, and the skin can look red, though this may be less noticeable on brown or black skin. Sometimes the skin may become cracked or bleed. Athlete's foot can also affect your soles or the sides of your feet, and sometimes causes fluid-filled blisters.

NICE CKS describes sub-types. The interdigital type is the most common and affects the toe web spaces first. The moccasin or dry type causes diffuse chronic scaling and thickening affecting the sole and side of the foot. The vesicobullous type is the least common, causing multiple small vesicles and blisters mainly on the arches and soles. It says there may be a history of itchy, flaky or painful skin on the feet.

NICE CKS describes fungal infection of the foot as a superficial skin infection of the feet and toes, predominantly caused by dermatophytes (a group of fungi). The NHS describes it as a common fungal infection that affects the feet which can keep coming back.

The NHS says that if it is not treated, the infection can spread to your toenails and cause a fungal nail infection. NICE CKS notes that infection is common in adolescents but rare in pre-pubertal children.

Yes. The NHS says you can catch athlete's foot from other people with the infection. You can get it by walking barefoot in places where someone else has athlete's foot, especially changing rooms and showers, or by touching the affected skin of someone with athlete's foot. You are more likely to get it if you have wet or sweaty feet, or if the skin on your feet is damaged.

NICE CKS lists risk factors as hot, humid climates or working environments, occlusive footwear, hyperhidrosis (excessive sweating), walking on contaminated surfaces and immunocompromised states. The NHS says you do not need to stay off work or school.

The NHS advises drying your feet after washing them, particularly between your toes, by dabbing them dry rather than rubbing, using a separate towel for your feet and washing it regularly, and wearing clean socks every day, with cotton socks best. It says not to scratch affected skin (this can spread it to other parts of your body), not to walk around barefoot in places like changing rooms and showers (wear flip-flops), not to share towels, socks or shoes, not to wear the same pair of shoes for more than 2 to 3 days in a row, and not to wear shoes that make your feet hot and sweaty.

The NHS stresses that you should keep following this advice after finishing treatment to help stop athlete's foot coming back, and says you can keep using some pharmacy treatments to stop it returning.

• Dab your feet dry after washing, especially between the toes.

• Use a separate towel for your feet and wash it regularly.

• Wear clean cotton socks every day.

• Wear flip-flops in changing rooms and showers.

• Do not share towels, socks or shoes.

• Rotate shoes so you do not wear the same pair more than 2 to 3 days in a row.

The NHS says to see a GP if treatments from a pharmacy do not work, you are in a lot of pain, your foot or leg is hot, painful and red (which could be a more serious infection), the infection spreads to other parts of your body such as your hands, you have diabetes (because foot problems can be more serious), or you have a weakened immune system, for example after an organ transplant or while having chemotherapy.

NICE CKS says that if signs of infection persist after topical antifungal treatment in adults, any cause of treatment failure should be managed, such as not following the self-care advice or treatment regimen, or reinfection from close contacts. It says skin sampling for fungal microscopy and culture should be arranged and oral antifungal treatment prescribed depending on results.

NICE CKS says fungal foot infection is common in adolescents but rare in pre-pubertal children. It says the antifungal cream treatment options apply to children as well as adults for mild, non-extensive disease, and that a referral to a dermatology specialist should be arranged if there is severe or extensive disease, or topical antifungal treatment is unsuccessful in a child.

The NHS says some pharmacy treatments are only suitable for adults, so check the packet or ask a pharmacist before using a product on a child.

On the NHS, a pharmacist is usually the first stop, and the NHS says a GP can help if pharmacy treatments do not work. Skin sampling and antifungal tablets are arranged through the GP.

If you see a private clinician, ask whether a skin scraping has been sent to confirm the diagnosis before long courses of tablets, and how treatment of any nail, hand or groin infection will be handled, since NICE CKS says treating those helps reduce the risk of reinfection.