Antifungal Drugs, Topical
Topical antifungal drugs are medicines applied to the skin to treat skin infections caused by a fungus.
Dermatologic fungal infections are usually described by their location on the body: tinea pedis (infection of the foot), tinea unguium (infection of the nails), tinia capitis (infection of the scalp.) Three types of fungus are involved in most skin infections: Trichophyton, Epidermophyton, and Microsporum. Mild infections are usually susceptible to topical therapy, however severe or resistant infections may require systemic treatment.
There are a large number of drugs currently available in topical form for fungal infections. Other than the imidazoles, (miconazole [Micatin, Miconazole], clotrimazole [Lotrimin], econazole [Spectazole], ketoconazole [Nizoral], oxiconazole [Oxistat], sulconazole [Exelderm]) and the allylamine derivatives (butenafine [Mentax], naftifine [Naftin], terbinafine [Lamisil]), the drugs in this therapeutic class are chemically distinct from each other. All drugs when applied topically have a good margin of safety, and most show a high degree of effectiveness. There are no studies comparing drugs on which to base a recommendation for drugs of choice. Although some of the topical antifungals are available over-thecounter, they may be as effective as prescription drugs for this purpose.
Traditional antifungal drugs such as undecylinic acid (Cruex, Desenex) and gentian violet (also known as crystal violet) remain available, but have a lower cure rate (complete eradication of fungus) than the newer agents and are not recommended. Tolnaftate (Tinactin) has a lower cure rate than the newer drugs, but may be used prophylactically to prevent infection.
All drugs are applied topically. Consult individual product information for specific application recommendations.
As with all topical products, selection of the dosage form may be as important as proper drug selection. Consider factors such as presence or absence of hair on the affected area, and type of skin to which the medication is to be applied. Thin liquids may preferable for application to hairy areas, creams for the hands and face, and ointments may be preferable for the trunk and legs. Other dosage forms available include shampoos and sprays. Ciclopirox and triacetin are available in formulations for topical treatment of nail fungus as well as skin infections (ciclopirox as Penlac Nail Lacquer and triacetin as Ony-Clear Nail).
Most topical antifungal drugs require four weeks of treatment. Infections in some areas, particularly the spaces between toes, may take up to six weeks for cure.
Most topical antifungal agents are well tolerated. The most common adverse effects are localized irritation caused by the vehicle or its components. This may
Topical antifungal drugs should only be applied in accordance with labeled uses. They are not intended or ophthalmic (eye) or otic (ear) use. Application to mucous membranes should be limited to appropriate formulations.
The antifungal drugs have not been evaluated for safety in pregnancy and lactation on topical application under the pregnancy risk category system. Although systemic absorption is probably low, review specific references. Gentian violet is labeled with a warning against use in pregnancy.
Topical antifungal drugs have no recognized drug-drug or food-drug interactions.
Samuel Uretsky, PharmD
Cream—A spreadable substance, similar to an ointment, but not as thick. Creams may be more appropriate than ointments for application to exposed skin areas such as the face and hands.
Ointment—A thick, spreadable substance that contains medicine and is meant to be used on the skin, or if a vaginal preparation, in the vagina.
Opthalmic—Pertaining to the eye.
Otic—Pertaining to the ear.
Topical—A term used to describe medicine that has effects only in a specific area, not throughout the body, particularly medicine that is put directly on the skin.