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Topical antifungal medications

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2003.

What are topical antifungal medications?

Topical antifungal medications are creams, solutions, lotions, powders, gels, sprays and lacquers applied to the skin surface to treat fungal infections. They can often cure localised infections, although recurrence is common. 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. Others are more specific to one or the other type of fungus. 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 general fungal skin infections

Topical antifungal creams can be used to treat:

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.

In other countries, additional antifungal agents include the azoles, bifonazole, tioconzaole, sulconazole, efinaconazole and luliconazole; naftifine; and a benzoxaborole, tavaborole.

Scalp antifungal agents

Antifungal shampoos are mainly used to treat dandruff / seborrhoeic dermatitis but are used as an adjunct for tinea capitis and scalp psoriasis.

The most effective ingredients are ketoconazole (Daktagold® shampoo; Ketopine® shampoo, Nizoral® shampoo; Sebizole® shampoo), miconazole (HairScience® shampoo) and ciclopirox (Stieprox® liquid), but many other shampoos marketed for dandruff have antifungal properties.

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.

Preparations for nail plate infections

Distal 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:

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.

Preparations for oral infections

Oral candidiasis can be treated with:

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:

* Unsuitable for dermatophyte fungal infections

Combination products

Topical antifungals may be sold with an oral antifungal, e.g. Canesten® combination pack (fluconazole capsule and clotrimazole cream duo).

Antifungal creams are sometimes combined with:

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

New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

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