- Athlete's foot is "unlikely to get better on its own". Pharmacy creams, sprays and powders "usually take a few weeks to work" (NHS, athlete's foot).
- Topical antifungals beat placebo for lab-confirmed foot infection. In a family-medicine summary of a 2007 Cochrane review, treatment failure at 6 weeks was 25% with allylamines such as terbinafine (9 trials, 876 people) vs 80% with placebo, and 28% with azoles (6 trials, 448 people) vs 70% with placebo (Tools for Practice 272). We read that summary, not the Cochrane review itself.
- For scalp ringworm in children, a 2016 Cochrane review found terbinafine cured Trichophyton tonsurans more often than griseofulvin (52.1% vs 35.4%), but cured Microsporum less often (34.7% vs 50.9%). Its authors rate the evidence low to moderate quality (Chen et al., Cochrane 2016).
- Oral terbinafine has liver warnings. The generic US label says liver failure has occurred, "some leading to liver transplant or death". It also says taste or smell changes "may be permanent" (DailyMed, generic terbinafine tablets).
- Terbinafine-resistant Trichophyton indotineae is an emerging problem. A French cluster of 10 patients, nine of whom came from or had visited Bangladesh, carried resistance mutations (Jabet et al., Emerging Infectious Diseases 2022). A 2025 review reports that over 80% of T. indotineae isolates have a terbinafine MIC90 of 0.5 µg/mL or more under CLSI methods, and lists oral itraconazole as a preferred alternative (Gupta et al., Antibiotics 2025).
- Tea tree oil is the natural remedy we checked most closely. A 2023 systematic review of 46 trial articles rates the research "poor to modest" and was funded by AgriFutures Australia. One foot trial found no difference from placebo (Kairey et al., 2023; TFP 272).
- Money trail: The generic terbinafine tablets we could check are distributed in the US by Bionpharma Inc. and made in India, and DailyMed lists at least five generic labelers (DailyMed search). The 2025 resistance review reports no external funding, but its competing-interests section says its authors were employed by Mediprobe Research Inc. (Gupta 2025).
- Evidence grade: Strong for topical terbinafine and azoles in athlete's foot. Moderate for oral terbinafine in scalp ringworm in children. Risk for oral terbinafine and for resistance. Insufficient for tea tree oil. Other home remedies are not graded (see gaps).
Independent evidence review · Prescription medicine and natural remedies
Topical antifungals are the best-supported treatment for athlete's foot, body ringworm and jock itch. Oral terbinafine has a role in scalp ringworm in some children, but it carries liver and taste warnings, so clinicians reserve it for stubborn or scalp disease. Terbinafine-resistant Trichophyton indotineae is a growing concern, first described in a French cluster, most of whose patients had links to Bangladesh. Tea tree oil is the natural remedy we checked most closely, but its research is rated poor to modest and one foot trial found no benefit. Our confidence: good for topical treatment of uncomplicated foot infection; moderate for the oral-drug picture; low for tea tree oil; no grade for other home remedies.
Table of contents
- Evidence summary
- What fungal skin infections are
- How the treatments work
- What works and what does not
- Benefits by claim
- Risks and all side effects
- All interactions
- Who should avoid oral terbinafine without advice
- Doses studied and how treatment is used
- Follow the money: who makes it and who funded the evidence
- Related research
- Frequently asked questions
- Sources and funding notes
Evidence summary
| Claim | Evidence | Source | Funding / conflict | Strength |
|---|---|---|---|---|
| Topical allylamines and azoles treat lab-confirmed athlete's foot | Allylamines: 9 trials, 876 people, failure 25% vs 80% placebo (NNT 2). Azoles: 6 trials, 448 people, failure 28% vs 70% placebo (NNT 3). Treatment periods 1 to 6 weeks. | TFP 272, summarising Crawford and Hollis, Cochrane 2007 | Summary authors declare no conflicts. Some underlying trials were industry funded. We did not open the 2007 review. | Strong |
| Oral terbinafine beats griseofulvin for T. tonsurans scalp ringworm | Cure 52.1% vs 35.4% (RR 1.47, 95% CI 1.22 to 1.77; moderate quality). | Chen et al., Cochrane 2016 | Funding statement not shown on the review page we opened. | Moderate |
| Griseofulvin beats oral terbinafine for Microsporum scalp ringworm | Cure 34.7% terbinafine (6 weeks) vs 50.9% griseofulvin (6 to 12 weeks), 334 children (RR 0.68, 95% CI 0.53 to 0.86; moderate quality). | Chen et al., Cochrane 2016 | As above. | Moderate |
| Oral terbinafine and griseofulvin have similar adverse-event rates in children | Adverse events attributed to the drugs: 9.2% vs 8.3% (RR 1.11, 95% CI 0.79 to 1.57). Severe events 0.6% in each group. The review page does not mention liver outcomes. | Chen et al., Cochrane 2016 | As above. | Moderate |
| Oral terbinafine can cause liver failure | Label: "Cases of liver failure, some leading to liver transplant or death, have occurred." Liver tests advised before prescribing and periodically after. | DailyMed generic label | Written by the distributor from approved labelling. Regulator-approved wording. | Risk |
| Oral terbinafine can cause lasting taste or smell loss | Label: taste and smell changes "may be prolonged (greater than 1 year), or may be permanent". Advises stopping the drug if either occurs. | DailyMed generic label | As above. | Risk |
| T. indotineae can resist terbinafine | France: 10 patients, squalene epoxidase substitutions. Review: over 80% of T. indotineae isolates have MIC90 at or above 0.5 µg/mL (CLSI); no clinical breakpoint yet; itraconazole preferred as an alternative. | Jabet 2022; Gupta 2025 | Jabet: funding not on the page we opened. Gupta: no external funding, but authors employed by Mediprobe Research Inc. | Risk |
| Tea tree oil cures athlete's foot | The 2023 review includes three podiatry trials (onychomycosis and two tinea pedis trials). Its own abstract says research quality was "poor to modest". The trial-level figures for the tinea pedis trials were not in the text we could read. | Kairey et al., 2023 | Review funded by AgriFutures Australia. One included dandruff trial (Satchell 2002a) lists the Australian Tea Tree Oil Research Institute as its funder. | Insufficient |
| Tea tree oil does not cure athlete's foot | One trial (71 people, 4 weeks) found no difference from placebo. The summary calls tea tree oil "likely ineffective". | TFP 272 | Summary authors declare no conflicts. | Moderate (against the claim) |
Independent evidence and credibility scorecard
Independence tiers: 1 = government or public health body with no product to sell; 2 = academic, Cochrane or professional-body work where no commercial funding is declared for the work (or no funding statement was found); 3 = authors with declared employment or an interest in the outcome; 4 = produced or distributed by the seller of the product. Credibility runs from A (highest) to D.
| Source | Who funds it | Country | Independence tier (1–4) | Credibility (A–D) | Why it would tell the truth / residual bias |
|---|---|---|---|---|---|
| NHS: athlete's foot | Public funding (NHS England) | UK | 1 | A | Public health body with no product to sell. Written for patients, so it gives no trial numbers and cannot be used to compare products. |
| NHS: ringworm | Public funding (NHS England) | UK | 1 | A | As above. The page does not mention steroid creams. |
| Chen et al., Cochrane 2016 (scalp ringworm in children) | Not stated on the review page we opened | International network; headquarters not verified | 2 | B | Systematic method, with a pooled analysis of 25 studies. But the authors themselves rate most of the evidence low to moderate quality, and we could not see which trials were industry funded. |
| Tools for Practice 272 (summary of Crawford and Hollis, Cochrane 2007) | Publisher: College of Family Physicians of Canada; funding of the summary not stated. Authors declare no conflicts | Canada | 2 | B | Written for family doctors and aimed at practical use. Relies on the 2007 review, which we did not open. Notes that some underlying trials were industry funded. |
| Jabet et al., Emerging Infectious Diseases 2022 | Not found on the page we opened (the full PDF has it) | France (authors); journal published in the US by the CDC | 2 | B | Peer-reviewed public-health journal with no product to sell. Only 10 patients, so it describes a cluster rather than a rate. |
| Kairey et al., 2023 (tea tree oil systematic review) | AgriFutures Australia (grant PRJ-012616); one included dandruff trial (Satchell 2002a) lists the Australian Tea Tree Oil Research Institute as funder | Australia (Southern Cross University) | 2 | B | Systematic review with a stated quality rating of "poor to modest". Its authors work in a naturopathic medicine centre, and its funder is a rural research body, so a pro-remedy tilt is possible. |
| Gupta et al., Antibiotics 2025 (terbinafine resistance review) | No external funding stated. Competing-interests section says all six listed authors were employed by Mediprobe Research Inc. | Canada (Mediprobe in London, Ontario; Gupta also lists the University of Toronto) | 3 | C | Thorough, up-to-date review that reports unfavourable resistance data. The authors' employer is a research company whose business we could not verify, and the paper says both that the authors were employed by it and that there were no commercial relationships. Read the data, not the conclusions alone. |
| DailyMed generic terbinafine tablets (Bionpharma Inc.) | Distributor Bionpharma Inc. (Princeton, NJ, per label); label content approved by FDA | US (distributor); made in India (OrBion Pharmaceuticals, per label) | 4 | B | The seller wrote the label, which carries a legal duty to warn and regulator-approved wording. But the layout and emphasis are the seller's. We used it only for the warnings it lists. The reference Lamisil label was not readable in our tools. |
Clustering note: the drug safety warnings come from the US label, and the French resistance case and the Gupta review come from Europe and North America. The strongest natural-remedy trials come from Australia and are linked to tea tree industry bodies. Sources come from three regulatory traditions (UK, US and Australia, with Canada for the family-medicine summary).
What fungal skin infections are
These are infections of the outer skin, hair or nails caused by dermatophyte fungi. The NHS says athlete's foot can be treated with medicines bought from a pharmacy (NHS ringworm). The main types are:
- Athlete's foot (tinea pedis): itchy patches between the toes, with soreness and flaking. (NHS athlete's foot).
- Body ringworm (tinea corporis) and jock itch (tinea cruris): a scaly rash on the body or groin, usually treated with antifungal creams, gels, sprays or tablets chosen by a pharmacist (NHS ringworm).
- Scalp ringworm (tinea capitis): mainly a childhood infection. The NHS says it usually needs prescription antifungal tablets and shampoo, so a GP visit is needed (NHS ringworm).
Diagnosis
The trials in the Canadian summary included only people with lab-confirmed (mycological) infection (TFP 272). That matters because other rashes can look similar, and a rash that does not respond to pharmacy treatment is a reason to see a GP (NHS athlete's foot). We did not open a source on the specific tests GPs use, so this article does not describe them.
Resistance is now part of the picture
Trichophyton indotineae is a species that can resist terbinafine. A 2022 case series from France described 10 patients, nine of whom came from or had visited Bangladesh, with widespread infection and resistance mutations in the squalene epoxidase enzyme (Jabet 2022). The 2025 review says that for this species, combinations of oral itraconazole with topical azoles are commonly used, and it advises against fluconazole and griseofulvin because of reported high-level resistance (Gupta 2025).
How the treatments work
- Terbinafine is an allylamine. The French T. indotineae cases carried mutations in squalene epoxidase (Jabet 2022). We did not open a separate source for the drug's full mechanism.
- Azoles, such as clotrimazole and miconazole, are the other main topical class (TFP 272). We did not open a source for their mechanism.
- Griseofulvin is an older oral drug. The 2025 review advises against it for T. indotineae because of reported high-level resistance (Gupta 2025).
Creams are applied to the skin where the infection sits. The NHS says scalp ringworm usually needs prescription tablets and shampoo, so tablets are the usual route for scalp disease (NHS ringworm).
What works and what does not
| Claimed benefit | Verdict | Evidence | Key caveat |
|---|---|---|---|
| Topical terbinafine or azole creams for athlete's foot | WORKS | Failure 25% and 28% vs 80% and 70% placebo at 6 weeks (TFP 272) | Needs weeks of use; some people need a different product |
| Topical treatment for body ringworm and jock itch | WORKS | First-line pharmacy advice (NHS ringworm); we did not open a trial for this site | Use for the full period, even after the rash has gone |
| Oral terbinafine for T. tonsurans scalp ringworm in children | WORKS | Cure 52.1% vs 35.4% griseofulvin (Chen 2016) | Worse than griseofulvin for Microsporum; liver and taste risks |
| Tea tree oil for athlete's foot | MIXED | Systematic review rates research "poor to modest" (Kairey 2023); one foot trial no better than placebo (TFP 272) | Positive older trials not verified in this review |
| Vinegar, garlic or coconut oil for athlete's foot | INSUFFICIENT | Not graded: we did not open a source for these in this review | Do not replace a proven antifungal |
Benefits by claim
Does athlete's foot clear with cream?
In trials, yes, for most people. Lab-confirmed treatment failure at 6 weeks was 25% with allylamines and 28% with azoles, against 80% and 70% with placebo (TFP 272). The NHS says creams, sprays and powders "usually take a few weeks to work" and that athlete's foot is unlikely to clear on its own (NHS athlete's foot). The summary also says some underlying trials were industry funded, but the trial-level funding was not in the part we read.
Is terbinafine better than azole creams?
We could not establish this. The Canadian summary reports the two classes separately against placebo, with failure rates of 25% and 28%, and does not give a direct head-to-head comparison in the text we read. We do not claim either class is superior.
Body ringworm and jock itch
The NHS advises asking a pharmacist first. Treatment may be needed daily for up to 4 weeks, and the NHS stresses using it for the right length of time, even after the rash has gone (NHS ringworm). This is public health guidance rather than a trial result, so we grade it moderate at most. We did not open a head-to-head trial for these sites.
Scalp ringworm in children
The choice depends on the fungal species, which is why a clinician should identify it. The 2016 Cochrane review found terbinafine better for T. tonsurans (52.1% vs 35.4%, moderate-quality evidence) and griseofulvin better for Microsporum (50.9% vs 34.7%, moderate-quality evidence). For Trichophyton overall, the difference was not significant (84.2% vs 79.0%, low-quality evidence). The review page does not mention liver outcomes (Chen 2016).
Does tea tree oil work?
The honest answer is that the evidence is weak and conflicting. A 2023 systematic review of 46 trial articles on tea tree oil across many conditions rated the quality of research as "poor to modest", and it calls for larger, better-reported trials (Kairey 2023). It includes three podiatry trials, two on tinea pedis (the 1992 trial by Tong and the 2002 trial by Satchell). We could not open either paper, so we do not report their figures. The most recent foot trial we read in the Canadian summary, with 71 people and 4 weeks of use, found no difference from placebo (TFP 272). Because the positive foot trials were not verified, tea tree oil is graded insufficient.
Vinegar, garlic and coconut oil
These remedies are common, but we did not open a trial or systematic review for any of them in this article, so we do not grade them. The NHS pages we read do not recommend them. That is a gap, not a finding of no benefit. Do not use a home remedy in place of a proven antifungal for a rash that is not improving.
Risks and all side effects
Depression
The label tells prescribers to watch for depressive symptoms and tells patients to report them to their doctor. It does not give a stop instruction for this warning (DailyMed label, section 5.4).
Other side effects in trials
In the children's review, the authors describe adverse events from the study drugs as mild and reversible. Adverse events attributed to the drugs were 9.2% with terbinafine and 8.3% with griseofulvin, and severe events were 0.6% in each group (Chen 2016). We did not open a source for the specific side-effect profile of creams or of tea tree oil, so we do not quote rates for them.
Tea tree oil
We did not verify skin-reaction rates for tea tree oil from a primary trial in this review. Anyone who tries it should check the product label and stop if the skin becomes red, sore or blistered.
Terbinafine resistance (T. indotineae)
The 2025 review says over 80% of T. indotineae isolates have a terbinafine MIC90 of 0.5 µg/mL or more under CLSI methods; the abstract gives a similar figure. The review notes that no clinical breakpoint exists yet, so susceptibility testing cannot reliably guide treatment on its own (Gupta 2025). The French cases carried squalene epoxidase substitutions (Jabet 2022). Resistance is not universal, so a rash that does not respond needs a clinician's review.
All interactions
We did not open the interaction section of the terbinafine label, so we do not list interactions. Because terbinafine is processed by the liver, the full label and a pharmacist should be checked before any combination. Any oral antifungal should be checked against the full list of current medicines.
Who should avoid oral terbinafine without advice
- People with diabetes or a weakened immune system: the NHS says to see a GP early for a fungal rash in these groups (NHS ringworm; NHS athlete's foot).
- People with existing liver disease: the label's liver warning applies to everyone, and it asks for liver tests before prescribing (DailyMed label). Only a clinician can judge the risk for an individual.
- Children: the NHS says some athlete's foot treatments are only for adults, so check the packet or ask a pharmacist (NHS athlete's foot). Scalp ringworm in children needs a GP (NHS ringworm).
- Pregnancy and breastfeeding: we did not open a source for the label guidance on this group. Ask a clinician.
Doses studied and how treatment is used
These are periods used in trials or stated in public guidance. They are not personal instructions, and they do not replace the product label or a clinician.
- Topical creams: NHS guidance for ringworm describes daily use for up to 4 weeks, continued for the full period even after the rash has gone (NHS ringworm). In the Canadian summary, allylamine trials ran 1 to 4 weeks and azole trials 4 to 6 weeks (TFP 272).
- Oral terbinafine in the children's review: 6 weeks for Microsporum comparisons, against 6 to 12 weeks for griseofulvin (Chen 2016). Adult oral dosing is set by the label and a clinician, and we did not extract it.
- Tea tree oil: trial concentrations and schedules for the foot trials were not verified in this review.
Product quality: Medicines sold in the UK and US are regulated, so the strength should be checked on the label. We did not open a systematic review of product quality for home remedies or herbal oils.
Follow the money: who makes it and who funded the evidence
Who makes and sells terbinafine tablets
The generic terbinafine tablet label we opened names Bionpharma Inc. (Princeton, NJ) as distributor, with the tablets made in India by OrBion Pharmaceuticals Private Limited (DailyMed label). A DailyMed search lists further oral terbinafine tablet labelers, including Breckenridge Pharmaceutical, Wockhardt Limited, Dr. Reddy's Laboratories Limited and Camber Pharmaceuticals (DailyMed search). We did not confirm the brand's owner or the originator's headquarters. Market size and the parent companies of these generic makers were not verified.
Who funded the trials and reviews
- Public and independent: The NHS pages come from a publicly funded health service with no product to sell. The Cochrane children's review does not show a funding statement on the page we opened, so its funders are unknown to us.
- Not shown or not verified: The Jabet 2022 French case series does not show a funding statement on the page we opened, and the full article was not open to us.
- Industry-linked: The 2023 tea tree review was funded by AgriFutures Australia, a rural research funder, and one included dandruff trial (Satchell 2002a) lists that institute as its funder (Kairey 2023). That trial was not a foot trial.
- Employer ties: The 2025 resistance review reports no external funding. Its competing-interests section says the authors were employed by Mediprobe Research Inc. (London, Ontario), and it also says the research was conducted without commercial or financial relationships (Gupta 2025). We could not verify Mediprobe's business. The ties are a reason to read the review closely, not a reason to reject its data.
Documented integrity events
We did not run a search for recalls, warning letters or lawsuits for these products, and the tools available for this review were not enough to do so. We therefore state no integrity event. The FDA-approved liver and taste warnings are product safety labelling, not an enforcement action.
Research funding at a glance
8 sources graded. The counts below are the independence tiers assigned in the scorecard above. They count sources, not funding amounts or evidence quality.
Public funding alone does not prove independence, and commercial funding alone does not prove a claim false. Named funders, countries and relationships are in the scorecard and source notes.
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Frequently asked questions
Will athlete's foot go away on its own?
The NHS says it is unlikely to get better on its own, and that pharmacy creams, sprays or powders usually take a few weeks to work (NHS).
Is terbinafine cream better than azole cream?
We could not establish this. The Canadian summary of a 2007 Cochrane review reports failure rates of 25% for allylamines and 28% for azoles against placebo, and does not give a direct comparison in the text we read (TFP 272).
Does tea tree oil cure athlete's foot?
The evidence is weak and conflicting. A 2023 systematic review rates the research as poor to modest and was funded by AgriFutures Australia (Kairey 2023). One foot trial found no difference from placebo (TFP 272).
Is oral terbinafine safe?
It is used for some scalp infections and for stubborn disease, but the generic US label warns of liver failure, sometimes leading to transplant or death, and of taste or smell changes that may be permanent (DailyMed label). Liver tests are advised before prescribing.
What is terbinafine-resistant ringworm?
It is infection with T. indotineae that responds poorly to terbinafine. A French case series of 10 patients described resistance mutations (Jabet 2022), and a 2025 review reports that over 80% of T. indotineae isolates have a terbinafine MIC90 of 0.5 µg/mL or more (Gupta 2025).
Are vinegar, garlic or coconut oil effective?
We did not open a trial or systematic review for these remedies in this article, so we cannot grade them. They should not replace a proven antifungal, and a rash that persists or spreads needs a clinician's review (NHS ringworm).
When should I see a GP?
See a GP if pharmacy treatment does not work, if the rash spreads, if the skin becomes hot, painful or red, if the scalp is affected, or if you have diabetes or a weakened immune system (NHS athlete's foot; NHS ringworm).
Sources and funding notes
What we could not verify: The FDA reference label for Lamisil did not load as readable text in our tools, so label wording comes from the generic Bionpharma label on DailyMed. The Cochrane foot review (Crawford and Hollis 2007, CD001434) was not opened, and its figures come from the Canadian summary. The 1992 tea tree trial (Tong) and the 2002 tea tree trial (Satchell) were not opened; PubMed blocked our access, and the 2023 review is the only other source we have for them. We did not run a search for natural remedies other than tea tree oil, for integrity events, or for the originator of the Lamisil brand, so those points are open. The funding of the French case series and the Cochrane children's review was not visible on the pages we opened. We did not check drug interactions, pregnancy guidance or prevention advice from a primary source.
- NHS: Athlete's foot. Public health guidance for patients. Public funding (NHS England).
- NHS: Ringworm. Public health guidance for patients. Public funding (NHS England).
- Chen X et al. Antifungal medicines for treating children with ringworm. Cochrane Database Syst Rev, 2016, CD004685. Systematic review of 25 studies with 4,449 children. Funding not shown on the page.
- College of Family Physicians of Canada: Tools for Practice 272, Putting the FUN in fungi (Part 2): Topical management of tinea pedis. Summary of Crawford and Hollis (Cochrane 2007, CD001434) and of a tea tree oil trial. Publisher: College of Family Physicians of Canada; funding of the summary not stated. Authors declare no conflicts.
- Jabet A et al. Extensive dermatophytosis caused by terbinafine-resistant Trichophyton indotineae, France. Emerging Infectious Diseases 2022. Case series of 10 patients. Journal published by the US CDC. Study funding not visible on the page we opened.
- Gupta AK et al. Terbinafine Resistance in Trichophyton rubrum and Trichophyton indotineae: A Literature Review. Antibiotics (Basel) 2025;14(5):472. No external funding stated; competing-interests section says authors were employed by Mediprobe Research Inc.
- Kairey L et al. Efficacy and safety of Melaleuca alternifolia (tea tree) oil for human health: a systematic review of randomized controlled trials, 2023. 46 articles. Funded by AgriFutures Australia (PRJ-012616). Quality "poor to modest".
- DailyMed: Terbinafine tablets, Bionpharma Inc. label. Generic label; distributor Bionpharma Inc.; made in India by OrBion Pharmaceuticals. Warnings in sections 5.1 to 5.4 read directly.
- DailyMed search: terbinafine. Used only to list further generic labelers. Page 1 of 6 read.
- Tong MM et al. Tea tree oil in the treatment of tinea pedis. Australas J Dermatol, 1992. Cited for its title only. The full text and funding were not read.
Educational research reviewed 9 October 2026. This article is not medical advice; talk to a qualified clinician or pharmacist before starting, stopping or combining treatments.
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