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Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2003.
Fungal skin infections are caused by:
A topical antifungal medication is a cream, solution, lotion, powder, gel, spray or lacquer applied to the skin surface to treat a fungal infection.
Many antifungal medications are suitable for both dermatophyte and yeast infections. Others are more specific to one or the other type of fungus. Those unsuitable for dermatophyte fungal infections are marked with an asterisk (*) in the list that follows.
Topical antifungals can be obtained over the counter without a doctor's prescription. They are generally applied to the affected area twice daily for two to four weeks, including a margin of several centimetres of normal skin. Treatment should continue for one or two weeks after the last visible rash has cleared. They can often cure a localised infection, although recurrence is common so repeated treatment is often necessary.
The most effective ingredients are ketoconazole, miconazole and ciclopirox (Stieprox® liquid), but many other shampoos marketed for dandruff have antifungal properties.
Distal onychomycosis can be treated with an antifungal lacquer 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 that:
Available preparations are:
Treatment needs to be undertaken for long periods (a year or longer) because nails take a long time to grow, especially in older individuals. Nail polish is not recommended, in case it interferes with the efficacy of the product, although this is not proven.
Oral candidiasis can be treated with:
Note: miconazole oral gel should not be used in patients who are taking warfarin because it has been reported to cause a dangerous interaction, which could result in serious bleeding.
Vulvovaginal candidiasis can be treated with:
* Unsuitable for dermatophyte fungal infections
Topical antifungals may be sold with an oral antifungal medication, for example, fluconazole capsule in combination with clotrimazole cream.
Antifungal creams are sometimes combined with:
Oral antifungal medications may be required for a fungal infection if:
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