Even with the best of home care, there may be times when your athlete's foot symptoms won't let up. You may have used an over-the-counter ointment for weeks without fail, only to find that the skin between your toes are still peeling, itching, and starting to swell and blister. Before it gets worse, you may need to see a doctor to obtain prescription foot medication.1
Athlete's foot (tinea pedis) is a common fungal infection that usually starts in the soft spaces between the toes. It is a hearty fungus that you can be easily pick up from swimming pools, bathrooms, showers, and locker room floors.
While many cases will respond to store-bought creams, ointments, powders, and sprays, others may be harder to treat and require a prescription-strength antifungal, either topical or oral.
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 doctor 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.2
When to Call a Doctor
Call your doctor immediately or seek urgent care if:
Your foot is swollen and developing red streaks.
There is a profuse discharge of pus or other fluids.
You develop a high fever and other signs of infection.
If your athlete's food fails to respond to over-the-counter medications, your physician will usually prescribe you prescription-strength versions of the same topical medications. These include:
Generally speaking, topical medicines will be prescribed first. 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 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.3
If a secondary infection has developed (usually when bacteria enters through open breaks int he skin), an oral antibiotic may be prescribed.4 Agents 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.5
The longer that athlete's foot persists, 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.6 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. Among them:
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.7
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 doctor 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.8
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.9
If you are pregnant or nursing, discuss your treatment options with your doctor so that you can make a fully informed choice.10 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. This is most notable with Diflucan but also applies to other commonly prescribed oral antifungals.
In most cases, a combination of topical antifungals and home care will provide sufficient relief. Topical drugs can be used throughout the pregnancy because of their limited absorption.
A Word From Verywell
Although mild cases of athlete's foot can usually be treated with over-the-counter ointments, severe or persistent cases may require prescription treatment.
If prescription drugs are needed, advise your doctor about any medical conditions you have or any drugs you may be taking (including vitamins, herbal remedies, and nutritional supplements).