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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 AntifungalVusion
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 of Topical antifungals:

View by  Brand | Generic
Drug Name Avg. Rating Reviews
Jublia (Pro)
Generic name: efinaconazole
5.5
217 reviews
Kerydin (Pro)
Generic name: tavaborole
4.6
32 reviews
Xolegel (Pro)
Generic name: ketoconazole
8.0
8 reviews
Lamisil AT (Pro)
Generic name: terbinafine
5.1
8 reviews
Vusion (Pro)
Generic name: miconazole / zinc oxide
9.8
4 reviews
Penlac Nail Lacquer
Generic name: ciclopirox
4.8
4 reviews
Nystop (Pro)
Generic name: nystatin
6.7
4 reviews
Nizoral Topical
Generic name: ketoconazole
7.0
4 reviews
Fungi-Nail
Generic name: undecylenic acid
6.2
4 reviews
Spectazole (Pro)
Generic name: econazole
9.7
3 reviews
Naftin (Pro)
Generic name: naftifine
10
3 reviews
M-Zole 3
Generic name: miconazole
1.0
3 reviews
Penlac (Pro)
Generic name: ciclopirox
4.5
2 reviews
Oxistat (Pro)
Generic name: oxiconazole
9.0
2 reviews
Nyamyc (Pro)
Generic name: nystatin
5.5
2 reviews
Nizoral Shampoo
Generic name: ketoconazole
7.0
2 reviews
Nizoral A-D
Generic name: ketoconazole
6.3
2 reviews
Micon 7
Generic name: miconazole
7.0
2 reviews
Loprox (Pro)
Generic name: ciclopirox
9.3
2 reviews
Lamisil AT Cream
Generic name: terbinafine
10
2 reviews
Canesten
Generic name: clotrimazole
2 reviews
Zeasorb-AF Drying Gel
Generic name: miconazole
10
1 review
Zeasorb-AF
Generic name: miconazole
10
1 review
Pedipirox-4
Generic name: ciclopirox
3.0
1 review
Pedi-Dri (Pro)
Generic name: nystatin
8.0
1 review
Mycostatin Topical (Pro)
Generic name: nystatin
7.0
1 review
Lotrimin AF Athlete's Foot Powder
Generic name: miconazole
9.0
1 review
FungiCURE Pump Spray
Generic name: clotrimazole
10
1 review
Extina (Pro)
Generic name: ketoconazole
10
1 review
Ertaczo (Pro)
Generic name: sertaconazole
7.5
1 review
Clarus Antifungal
Generic name: tolnaftate
8.0
1 review
Athletes Foot Cream
Generic name: terbinafine
1 review
Versiclear
Generic name: salicylic acid / sodium thiosulfate
No reviews
Undelenic
Generic name: undecylenic acid
No reviews
Triple Paste AF
Generic name: miconazole
No reviews
Ting
Generic name: tolnaftate
No reviews
Tinaspore
Generic name: tolnaftate
No reviews
Tinamar
Generic name: tolnaftate
No reviews
Tinaderm
Generic name: tolnaftate
No reviews
Tinactin Jock Itch
Generic name: tolnaftate
No reviews
Tinactin
Generic name: tolnaftate
10
No reviews
Tetterine
Generic name: miconazole
No reviews
Soothe & Cool Inzo
Generic name: miconazole
No reviews
Secura Antifungal Extra Thick
Generic name: miconazole
No reviews
Secura Antifungal
Generic name: miconazole
No reviews
Rash Relief Antifungal
Generic name: miconazole / zinc oxide
No reviews
Q-Naftate
Generic name: tolnaftate
No reviews
Podactin
Generic name: tolnaftate
No reviews
Pediaderm AF (Pro)
Generic name: nystatin
No reviews
Ony-Clear
Generic name: miconazole
No reviews
Nyata
Generic name: nystatin
No reviews
NuZole
Generic name: miconazole
No reviews
Naftin-MP
Generic name: naftifine
No reviews
Myco Nail A
Generic name: undecylenic acid
No reviews
Mycocide NS
Generic name: tolnaftate
No reviews
Mycelex (Pro)
Generic name: clotrimazole
No reviews
Monistat-Derm (Pro)
Generic name: miconazole
No reviews
Mitrazol
Generic name: miconazole
No reviews
Miranel AF
Generic name: miconazole
No reviews
Micro-Guard
Generic name: miconazole
No reviews
Micatin
Generic name: miconazole
No reviews
Micaderm
Generic name: miconazole
No reviews
Mentax (Pro)
Generic name: butenafine
No reviews
Luzu
Generic name: luliconazole
No reviews
Lotrimin Ultra Athlete's Foot Cream
Generic name: butenafine
No reviews
Lotrimin AF Jock Itch Powder Spray
Generic name: miconazole
No reviews
Lotrimin AF Deodorant Powder Spray
Generic name: miconazole
No reviews
Lotrimin AF Athlete's Foot Cream
Generic name: clotrimazole
No reviews
Loprox TS
Generic name: ciclopirox
No reviews
Lamisil AT Spray (Pro)
Generic name: terbinafine
No reviews
Lamisil AT Cream for Jock Itch (Pro)
Generic name: terbinafine
No reviews
Lamisil AF Defense
Generic name: tolnaftate
No reviews
Kuric
Generic name: ketoconazole
No reviews
Ketodan (Pro)
Generic name: ketoconazole
No reviews
Fungoid
Generic name: miconazole
No reviews
Fungi-Guard
Generic name: tolnaftate
No reviews
Exoderm
Generic name: salicylic acid / sodium thiosulfate
No reviews
Exelderm (Pro)
Generic name: sulconazole
No reviews
Elon Dual Defense Anti-Fungal Formula
Generic name: undecylenic acid
No reviews
Ecoza (Pro)
Generic name: econazole
No reviews
Desenex Jock Itch
Generic name: miconazole
No reviews
Desenex Antifungal Foot Cream
Generic name: miconazole
No reviews
Desenex Antifungal Cream
Generic name: clotrimazole
No reviews
Desenex Antifungal Atheletes Foot Spray Liquid
Generic name: miconazole
No reviews
Dermagran AF
Generic name: miconazole
2.0
No reviews
DermaFungal
Generic name: miconazole
No reviews
Cruex Prescription Strength
Generic name: miconazole
No reviews
Cruex
Generic name: undecylenic acid
No reviews
Critic-Aid Clear AF
Generic name: miconazole
No reviews
CNL8 Nail (Pro)
Generic name: ciclopirox
No reviews
Blis-To-Sol Powder
Generic name: undecylenic acid
10
No reviews
Blis-To-Sol
Generic name: tolnaftate
No reviews
Baza Antifungal
Generic name: miconazole
10
No reviews
Azolen
Generic name: miconazole
No reviews
Aloe Vesta 2 in 1 Antifungal
Generic name: miconazole
No reviews
Aloe Vesta
Generic name: miconazole
No reviews
Aftate
Generic name: tolnaftate
No reviews
Absorbine Jr Antifungal
Generic name: tolnaftate
No reviews
Absorbine Athlete's Foot
Generic name: tolnaftate
No reviews
For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective).

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.