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