Topical antifungal medications

Topical antifungal medications can often cure fungal infections. Many suitable creams can be obtained over the counter without a doctor's prescription.

Many antifungal medications are suitable for both dermatophyte and yeast infections. The medications available in New Zealand are listed below, with their trade names in parentheses.

Those unsuitable for dermatophyte fungal infections are marked with an asterix (*).

Preparations for skin infections

Topical antifungal creams can be used to treat:

• Dermatophyte infections such as tinea corporis, tinea cruris, tinea faciei, tinea manuum, tinea pedis.
• As an adjunct to oral therapy for tinea capitis and tinea barbae.
• Yeast infections such as candida intertrigo, pityriasis versicolor.
• Mould skin infections such as tinea nigra.

The creams are applied to the affected area twice daily for two to four weeks, including a margin of several centimetres of normal skin. Continue for one or two weeks after the last visible rash has cleared. Repeated treatment is often necessary.

• Whitfield's ointment (benzoic acid)
• Undecylenic alkanolamide
• Ciclopirox olamine (Batrafen® cream, powder, solution)
• Polyenes *
  • Nystatin (Nilstat® cream, ointment; Mycostatin® cream, ointment, paste)
• Imidazoles
  • Bifonazole (Canesten® Once Daily Bifonazole Cream)
  • Clotrimazole (Canesten® cream, solution; Clocreme® cream; Clomazol®, Fungizid® spray)
  • Econazole (Ecreme® cream; Pevaryl® cream, powder, foaming solution)
  • Ketoconazole (Daktagold® shampoo; Ketopine® shampoo, Nizoral® cream, shampoo; Sebizole® shampoo)
  • Miconazole (Daktarin® cream, lotion, powder, spray; HairScience® shampooo for dandruff; Micreme® cream, Resolve® solution, tinea cream, jock itch cream, thrush cream, powder; Tinasolve®)
  • Tioconazole
• Allylamine (higher cure rates and more rapid responses than older topical antifungals for dermatophyte infections)
  • Terbinafine (Lamisil® cream, gel, spray)
• Thiocarbamates
  • Tolciclate
  • Tolnaftate

In other countries, additional antifungal agents include the azoles, bifonazole, tioconzaole, sulconazole; and naftifine.

Preparations for nail fold infections

There are many antiseptic and antifungal preparations to control nail fold infections (paronychia). They should be applied two or three times daily for several months.

• Thymol 3% in chloroform
• Sulfacetamide 15% in spirit
• Econazole solution (Pevaryl® solution)
• Miconazole (Daktarin® tincture; Fungo® solution)

Preparations for nail plate infections

Mild onychomycosis can be treated with antifungal lacquers applied once or twice weekly. The medication should be applied to the surface of the cleaned nail plate after it has been roughened using an emery board. Extra lacquer should be applied under the edge of the nail.

These can be expected to reduce and sometimes cure the infection provided:

• No more than 80% of the nail plate is infected
• The growing part of the nail plate (the matrix) is not involved
• There is no complicating internal disease (such as diabetes) or skin condition (such as psoriasis)

Available preparations are:

• The morpholine, amorolfine (Loceryl®, Nail lacquer)
• Ciclopirox (Nail Batrafen®, )

Preparations for oral infections

Oral candidiasis can be treated with:

• Nystatin * (Nilstat® oral drops, capsules, powder, tablets)
• Amphotericin B * (Fungilin® lozenges, oral suspension)
• Miconazole (Daktarin® oral gel)

Note: miconazole oral gel should not be usd in patients who are taking warfarin because it has been reported to cause a dangerous interaction, which could result in serious bleeding.

Preparations for vaginal infections

Vulvovaginal candidiasis can be treated with:

• Nystatin * (Nilstat® vaginal cream & pessaries)
• Clotrimazole (Canesten® vaginal cream & tablets; Clocreme® pessary, vaginal cream; Clomazol® Vaginal cream; Clotrimaderm® vaginal cream)
• Econazole (Pevaryl® ovules)
• Isoconazole
• Miconazole
• Tioconazole

* Unsuitable for dermatophyte fungal infections

Combination products

Antifungal creams are sometimes combined with:

• Hydrocortisone or other topical steroid (e.g. Resolve® Plus cream)
• Antibacterial agents
• Both topical steroid and antibacterial agent

Oral antifungal medications may be required for a fungal infection if:

• It is extensive or severe.
• It resists topical antifungal therapy.
• It affects hair-bearing areas (tinea capitis and tinea barbae).