Topical antifungals
What are Topical antifungals?
Topical antifungals are products that treat fungal infections and which are applied directly to the skin, nails, or hair; vaginally; or inside the mouth. They are available as creams, gels, lotions, nail lacquers, ointments, powders, shampoos, sprays, and tinctures.
Fungal infections are caused by dermatophytes, yeasts, or molds.
There are about 40 different species of dermatophyte, and they obtain their nutrients from keratinized material, so typically are the organisms responsible for fungal infections of the skin, scalp or nails.
Yeasts are normal inhabitants of our skin but sometimes they grow unheeded which can result in symptomatic infections. Molds are an uncommon cause of fungal infections but they can cause tinea nigra (painless brown or black patches on the skin) or hard-to-treat nail infections.
Most antifungal agents treat both dermatophyte and yeast infections; however, some, such as nystatin, are not suitable for dermatophyte fungal infections.
What are topical antifungals used for?
Topical antifungals may be used to treat fungal infections of the skin, scalp, mucous membranes, nails, and vagina. Examples of infections that topical antifungals may treat include:
- Candida infections
- Nail infections
- Pityriasis versicolor (causes flaky, discolored patches of skin)
- Tinea barbae (fungal infection of the beard and mustache area)
- Tinea capitis (fungal infection of the scalp)
- Tinea corporis (ringworm)
- Tinea cruris (jock itch)
- Tinea faciei (facial fungal infection)
- Tinea manuum (fungal infection of the hands)
- Tinea nigra
- Tinea pedis (fungal infection of the foot).
Other fungal infections not listed here may also be treated with topical antifungals.
What are the differences between topical antifungals?
Antifungal agents may be classified into a number of different types, depending on their structure and the way that they work. Many topical antifungals work by inhibiting production of ergosterol, a fundamental component of the fungal cell membrane and wall.
Note that only the antifungals that are available topically are listed here.
Azole antifungals
Azole antifungals are further classified into imidazoles and triazoles. Although all azoles work in the same way (by inhibiting an enzyme that converts lanosterol into ergosterol), there are differences in the spectrum of activity between imidazoles and triazoles.
Azole antifungals are metabolized through cytochrome p450 liver enzymes and are particularly susceptible to clinically-significant drug interactions with other medications metabolized through the same pathway, although this tends to only apply to topical products used inside the mouth, such as miconazole oral gel.
| Generic name | Brand name examples |
|---|---|
| Imidazoles | |
| clotrimazole | FungiCURE, Lotrimin |
| econazole | Ecoza, Spectazole |
| ketoconazole | Nizoral topical |
| miconazole | Azolen, Zeasorb |
| miconazole/zinc oxide | Rash Relief Antifungal, Vusion |
| oxiconazole | Oxistat |
| sertaconazole | Ertaczo |
| tioconazole | 1-day, Vagistat-1 |
| Triazoles | |
| efinaconazole | Jublia |
Polyene antifungals
Polyenes work by binding to ergosterol, disrupting the integrity of the fungal cell membrane. Nystatin is the only polyene antifungal available topically. Note that nystatin is not effective against dermatophyte infections but can be used to treat Candida infections.
| Generic name | Brand name examples |
|---|---|
| nystatin | Mycostatin topical, Nyamyc |
Allylamine antifungals
Allylamines work in a similar way to azoles but have their effect earlier on in the ergosterol synthesis pathway. They inhibit the enzyme squalene epoxidase which converts squalene into ergosterol, disrupting synthesis of the fungal cell wall.
Terbinafine is also metabolized by cytochrome p450 liver enzymes and is particularly susceptible to clinically-significant drug interactions with other medications metabolized through this pathway, although this tends not to apply to topical products.
| Generic name | Brand name examples |
|---|---|
| amorolfin | Not available in the U.S. |
| naftifine | Naftin |
| terbinafine | Lamisil |
Other antifungals
Several other topical antifungals are available. Their mechanism of action differs to the antifungals listed above.
| Generic name | Brand name examples |
|---|---|
| Benzoic acid and salicylic acid | Bensal HP |
| ciclopirox | Ciclodan, Loprox |
| tavaborole | Kerydin |
| tolnaftate | Tinactin |
| undecylenic acid | Blis-To-Sol, Protectol |
Are topical antifungals safe?
Topical antifungals are considered safe when used exactly as directed according to the product label. However, certain topical antifungals have been associated with serious side effects, for example:
- Miconazole oral gel: Should not be used in infants with an impaired swallowing reflex or in preterm infants in their first six months of life, or in babies less than four months old, because of the potential for airway obstruction
- Miconazole oral gel: May also cause clinically significant interactions with medicines (such as warfarin) metabolized through the same liver pathway because miconazole oral gel is absorbed through the mouth.
For a complete list of severe side effects, please refer to the individual drug monographs.
What are the side effects of topical antifungals?
Not everybody will experience side effects from topical antifungals. Some of the more commonly reported side effects include:
- Burning or stinging
- Rash
- Sensitivity reactions
- Skin irritation (redness, peeling, swelling).
Some vaginal topical antifungal preparations have been associated with burning, cramping, itching, pain, and bleeding.
For a complete list of side effects, please refer to the individual drug monographs.
List drug with Topical antifungals
| Drug Name |
|---|
| Absorbine Athletes Foot Generic name: Tolnaftate Topical |
| Absorbine Jr. Antifungal Generic name: Tolnaftate Topical |
| Aftate Generic name: Tolnaftate |
| Aloe Vesta 2-N-1 Antifungal Generic name: Miconazole |
| Aloe Vesta Antifungal Generic name: Miconazole |
| Athlete's Foot Cream Generic name: Terbinafine Topical |
| Azolen Generic name: Miconazole Topical |
| Clarus Antifungal Generic name: Tolnaftate Topical |
| Clioquinol Generic name: Clioquinol |
| CNL8 Generic name: Ciclopirox |
| CNL8 Nail Generic name: Ciclopirox Topical |
| Critic-Aid Clear AF Generic name: Miconazole Topical |
| Cruex Generic name: Undecylenic Acid |
| Cruex Prescription Strength Generic name: Miconazole Topical |
| Myco Nail A Generic name: Undecylenic Acid Topical |
| Mycocide NS Generic name: Tolnaftate Topical |
| Mycostatin Generic name: Nystatin |
| Mycostatin Topical Generic name: Nystatin Topical |
| Baza Antifungal Generic name: Miconazole Topical |
| Blis-To-Sol Generic name: Tolnaftate Topical |
| Blis-To-Sol (Tolnaftate Topical) Generic name: Tolnaftate |
| Blis-To-Sol (Undecylenic acid Topical) Generic name: Undecylenic Acid |
| Blis-To-Sol Powder Generic name: Undecylenic Acid Topical |
| Butenafine Generic name: Butenafine |
| Butenafine topical Generic name: Butenafine Topical |
| Caldesene Generic name: Undecylenic Acid |
| Ciclopirox Generic name: Ciclopirox |
| Ciclopirox topical Generic name: Ciclopirox Topical |
| DermaFungal Generic name: Miconazole Topical |
| Dermagran AF Generic name: Miconazole Topical |
| Dermasept Antifungal Generic name: Tolnaftate |
| Desenex Foot Generic name: Miconazole Topical |
| Desenex Jock Itch Generic name: Miconazole Topical |
| Econazole Generic name: Econazole |
| Econazole Nitrate Generic name: Econazole Topical |
| Econazole topical Generic name: Econazole Topical |
| Ecoza Generic name: Econazole Topical |
| Efinaconazole Generic name: Efinaconazole |
| Efinaconazole topical Generic name: Efinaconazole Topical |
| Elon Dual Defense Anti-Fungal Formula Generic name: Undecylenic Acid Topical |
| Ertaczo Generic name: Sertaconazole Topical |
| Exelderm Generic name: Sulconazole Topical |
| Exoderm Generic name: Salicylic Acid And Sodium Thiosulfate Topical |
| Extina Generic name: Ketoconazole Topical |
| Fungi-Guard Generic name: Tolnaftate Topical |
| Fungi-Nail Generic name: Undecylenic Acid Topical |
| Fungi-Nail Pen Generic name: Undecylenic Acid Topical |
| Fungicure Generic name: Undecylenic Acid Topical |
| Fungoid Generic name: Miconazole Topical |
| Jublia Generic name: Efinaconazole Topical |
| Kerydin Generic name: Tavaborole Topical |
| Ketoconazole topical Generic name: Ketoconazole Topical |
| Ketodan Generic name: Ketoconazole Topical |
| Ketodan Kit Generic name: Ketoconazole |
| Kuric Generic name: Ketoconazole Topical |
| LamISIL (Terbinafine Topical) Generic name: Terbinafine |
| Lamisil AT Generic name: Terbinafine Topical |
| LamISIL Defense Generic name: Tolnaftate Topical |
| Loprox Generic name: Ciclopirox Topical |
| Loprox TS Generic name: Ciclopirox |
| Lotrimin Generic name: Clotrimazole |
| Lotrimin AF Generic name: Miconazole Topical |
| Lotrimin AF (Clotrimazole Topical) Generic name: Clotrimazole |
| Lotrimin AF (Miconazole Topical) Generic name: Miconazole |
| Lotrimin AF Cream Generic name: Clotrimazole Topical |
| Lotrimin AF Deodorant Powder Spray Generic name: Miconazole Topical |
| Lotrimin AF For Her Generic name: Clotrimazole Topical |
| Lotrimin AF Jock Itch Generic name: Clotrimazole Topical |
| Lotrimin AF Powder Spray Generic name: Miconazole Topical |
| Luliconazole Generic name: Luliconazole |
| Luliconazole topical Generic name: Luliconazole Topical |
| Luzu Generic name: Luliconazole Topical |
| Mentax Generic name: Butenafine Topical |
| Micaderm Generic name: Miconazole Topical |
| Micatin Generic name: Miconazole Topical |
| Miconazole and zinc oxide topical Generic name: Miconazole And Zinc Oxide Topical |
| Miconazole, zinc oxide, and white petrolatum Generic name: Miconazole, Zinc Oxide, And White Petrolatum |
| Micro-Guard Generic name: Miconazole Topical |
| Mitrazol Generic name: Miconazole Topical |
| Monistat Derm Generic name: Miconazole |
| Naftifine Generic name: Naftifine |
| Naftifine topical Generic name: Naftifine Topical |
| Naftin Generic name: Naftifine Topical |
| Naftin-MP Generic name: Naftifine |
| Nizoral (Ketoconazole Topical) Generic name: Ketoconazole |
| Nizoral A-D Generic name: Ketoconazole Topical |
| Nizoral Topical Generic name: Ketoconazole Topical |
| NuZole Generic name: Miconazole Topical |
| Nyamyc Generic name: Nystatin Topical |
| Nystatin (Vaginal) Generic name: Nystatin |
| Nystatin topical Generic name: Nystatin Topical |
| Nystop Generic name: Nystatin Topical |
| Odor-Eaters Generic name: Tolnaftate Topical |
| Ony-Clear Generic name: Miconazole Topical |
| Oxiconazole Generic name: Oxiconazole |
| Oxiconazole topical Generic name: Oxiconazole Topical |
| Oxistat Generic name: Oxiconazole Topical |
| Pedi-Dri Generic name: Nystatin Topical |
| Pediaderm AF Generic name: Nystatin Topical |
| Pedipirox-4 Generic name: Ciclopirox Topical |
| Penlac Generic name: Ciclopirox Topical |
| Penlac Nail Lacquer Generic name: Ciclopirox Topical |
| Podactin Generic name: Tolnaftate |
| Q-Naftate Generic name: Tolnaftate |
| Rash Relief Antifungal Generic name: Miconazole And Zinc Oxide Topical |
| Remedy Antifungal with Olivamine Generic name: Miconazole Topical |
| Salicylic acid and sodium thiosulfate topical Generic name: Salicylic Acid And Sodium Thiosulfate Topical |
| Secura Antifungal Generic name: Miconazole Topical |
| Secura Antifungal Extra Thick Generic name: Miconazole Topical |
| Sertaconazole Generic name: Sertaconazole |
| Sertaconazole topical Generic name: Sertaconazole Topical |
| Silka Antifungal Generic name: Terbinafine Topical |
| Spectazole Generic name: Econazole |
| Sulconazole Generic name: Sulconazole |
| Sulconazole topical Generic name: Sulconazole Topical |
| Tavaborole Generic name: Tavaborole |
| Tavaborole topical Generic name: Tavaborole Topical |
| Terbinafine topical Generic name: Terbinafine Topical |
| Tetterine Generic name: Miconazole Topical |
| Tinactin Generic name: Tolnaftate Topical |
| Tinaderm Generic name: Tolnaftate Topical |
| Tinaspore Generic name: Tolnaftate Topical |
| Ting Generic name: Tolnaftate |
| Tolnaftate Generic name: Tolnaftate |
| Tolnaftate topical Generic name: Tolnaftate Topical |
| Triple Paste AF Generic name: Miconazole Topical |
| Undecylenic acid Generic name: Undecylenic Acid |
| Undecylenic acid topical Generic name: Undecylenic Acid Topical |
| Undelenic Generic name: Undecylenic Acid Topical |
| Versiclear Generic name: Salicylic Acid And Sodium Thiosulfate Topical |
| Vusion Generic name: Miconazole And Zinc Oxide Topical |
| Xolegel Generic name: Ketoconazole Topical |
| Zeasorb-AF Generic name: Miconazole Topical |
| Zeasorb-AF Drying Gel Generic name: Miconazole Topical |
| Zeasorb-AF Jock Itch Generic name: Miconazole Topical |
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