by itself) in 30–40% of cases. topical antifungal medication consistently produces much higher rates of cure. conventional treatment typically involves thoroughly washing the feet daily or twice daily, followed by the application of a topical medication. because the outer skin layers are damaged and susceptible to reinfection, topical treatment generally continues until all layers of the skin are replaced, about 2–6 weeks after symptoms disappear. keeping feet dry and practicing good hygiene (as described in the above section on prevention) is crucial for killing the fungus and preventing reinfection. treating the feet is not always enough. once socks or shoes are infested with fungi, wearing them again can reinfect (or further infect) the feet. socks can be effectively cleaned in the wash by adding bleach or by washing in water 60 °c (140 °f). to be effective, treatment includes all infected areas (such as toenails, hands, torso, etc.). otherwise, the infection may continue to spread, including back to treated areas. for example, leaving fungal infection of the nail untreated may allow it to spread back to the rest of the foot, to become athlete's foot once again. allylamines such as terbinafine are considered more efficacious than azoles for the treatment of athlete's foot. severe or prolonged fungal skin infections may require treatment with oral antifungal medication. topical treatments there are many topical antifungal drugs useful in the treatment of athlete's foot including: miconazole nitrate, clotrimazole, tolnaftate (a synthetic thiocarbamate), terbinafine hydrochloride, butenafine hydrochloride and undecylenic acid. the fungal infection may be treated with topical antifungal agents, which can take the form of a spray, powder, cream, or gel. topical application of an antifungal cream such as butenafine once daily for one week or terbinafine once daily for two weeks is effective in most cases of athlete's foot and is more effective than application of miconazole or clotrimazole. plantar-type athlete's foot is more resistant to topical treatments due to the presence of thickened hyperkeratotic skin on the sole of the foot. keratolytic and humectant medications such as urea, salicyclic acid (whitfield's ointment), and lactic acid are useful adjunct medications and improve penetration of antifungal agents into the thickened skin. topical glucocorticoids are sometimes prescribed to alleviate inflammation and itching associated with the infection. a solution of 1% potassium permanganate dissolved in hot water is an alternative to antifungal drugs. potassium permanganate is a salt and a strong oxidizing agent. oral treatments for severe or refractory cases of athlete's foot oral terbinafine is more effective than griseofulvin. fluconazole or itraconazole may also be taken orally for severe athlete's foot infections. the most commonly reported adverse effect from these medications is gastrointestinal upset. epidemiology globally, fungal infections affect about 15% of the population and 20% of adults. additionally, 70% of the population will experience athlete's foot at some point in life. athlete's foot is common in individuals who wear unventilated (occlusive) footwear, such as rubber boots or vinyl shoes. upon exposure to an athlete's foot-causing fungus, the moist conditions generated from poor foot ventilation promotes growth of the fungus on the foot or between the toes. occupationally, studies have shown increased prevalence of athlete's foot among miners, soldiers, and athletes. likewise, activities such as marathon running have seen increased prevalence of athlete's foot. countries and regions where going barefoot is more common experience much lower rates of athlete's foot than do populations which habitually wear shoes; as a result, the disease has been called "a penalty of civilization". studies have demonstrated that men are infected 2–4 times more often than women. cases of athlete's foot were first documented around 1916 during world war 1, where infection among soldiers was common. by 1928 it was estimated that nearly ten million americans with cases of athlete's foot; the alarming prevalence of the disease caused for public health concern. in the following year, an epidemiologic study was conducted on incoming freshman to the university of california; it was found that 53% of incoming freshman men had athlete's foot and by year's end that number had risen to 78%. prevalence of the disease increased in the 1930's, specifically among individuals of higher socioeconomic status; these individuals had more access to common shared spaced such as pools, colleges, and athletic clubs where transmission of athlete's foot-causing fungus was common. prevalence in the united states was high enough to call for the use of sterilizing footbaths in the 1932 olympics in los angeles. it was at this time public health officials adopted the idea that athletes foot was a product of modernity and that dealing with this disease was "a penalty of civilization" as many treatments proved ineffective. antifungal properties of compounds such as undecylenic acid were studied in the 1940's; products containing zinc undecylenate were shown to be the most effective topical treatment for curing the condition. the use of orally ingested griseofulvin was shown in the 1960's to be effective in acute cases of athlete's foot. likewise, recorded incidence of athletes foot decreased among american soldiers in vietnam who were given griseofulvin as a preventative drug. in the 1990's research supported the use of itraconazole and the allylamine known as terbinafine as drugs effective at eliminating athlete's foot and also dermatophyte infections on other parts of the body. as of 2012, research has shown that terbinafine is 2.26 times as likely to cure athlete's foot than treatment with griseofulvin; comparative studies between itraconazole and terbinafine have shown little difference in effectiveness.