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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:

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:

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Drug Name Reviews Avg. Ratings
Blis-To-Sol Powder
generic name: undecylenic acid
0 reviews
   
10
Extina (Pro)
generic name: ketoconazole
1 review
   
10
Mycostatin Topical (Pro)
generic name: nystatin
0 reviews
   
10
Naftin (Pro)
generic name: naftifine
2 reviews
   
10
Nizoral Topical (Pro)
generic name: ketoconazole
2 reviews
   
10
Nyamyc (Pro)
generic name: nystatin
1 review
   
10
Tinactin
generic name: tolnaftate
0 reviews
   
10
Zeasorb-AF
generic name: miconazole
1 review
   
10
Zeasorb-AF Drying Gel
generic name: miconazole
1 review
   
10
Vusion (Pro)
generic name: miconazole / zinc oxide
4 reviews
   
9.8
Spectazole (Pro)
generic name: econazole
3 reviews
   
9.7
Loprox (Pro)
generic name: ciclopirox
2 reviews
   
9.3
Lotrimin AF Athlete's Foot Powder
generic name: miconazole
1 review
   
9.0
Oxistat (Pro)
generic name: oxiconazole
2 reviews
   
9.0
Pedi-Dri (Pro)
generic name: nystatin
1 review
   
8.0
Penlac (Pro)
generic name: ciclopirox
1 review
   
8.0
Xolegel (Pro)
generic name: ketoconazole
8 reviews
   
8.0
Ertaczo (Pro)
generic name: sertaconazole
1 review
   
7.5
Micon 7
generic name: miconazole
2 reviews
   
7.0
Nizoral Shampoo
generic name: ketoconazole
2 reviews
   
7.0
Nizoral A-D
generic name: ketoconazole
2 reviews
   
6.3
Jublia (Pro)
generic name: efinaconazole
129 reviews
   
5.7
Nystop (Pro)
generic name: nystatin
3 reviews
   
5.5
Penlac Nail Lacquer
generic name: ciclopirox
3 reviews
   
5.5
Lamisil AT (Pro)
generic name: terbinafine
6 reviews
   
5.0
Kerydin (Pro)
generic name: tavaborole
27 reviews
   
4.9
Pedipirox-4
generic name: ciclopirox
1 review
   
3.0
Dermagran AF
generic name: miconazole
0 reviews
   
2.0
Fungi-Nail
generic name: undecylenic acid
1 review
   
1.0
M-Zole 3
generic name: miconazole
1 review
   
1.0
Absorbine Athlete's Foot
generic name: tolnaftate
0 reviewsAdd rating
Absorbine Jr Antifungal
generic name: tolnaftate
0 reviewsAdd rating
Aftate
generic name: tolnaftate
0 reviewsAdd rating
Aloe Vesta
generic name: miconazole
0 reviewsAdd rating
Aloe Vesta 2 in 1 Antifungal
generic name: miconazole
0 reviewsAdd rating
Athletes Foot Cream
generic name: terbinafine
0 reviewsAdd rating
Azolen
generic name: miconazole
0 reviewsAdd rating
Baza Antifungal
generic name: miconazole
0 reviewsAdd rating
Blis-To-Sol
generic name: tolnaftate
0 reviewsAdd rating
Canesten
generic name: clotrimazole
2 reviewsAdd rating
Clarus Antifungal
generic name: tolnaftate
0 reviewsAdd rating
CNL8 Nail (Pro)
generic name: ciclopirox
0 reviewsAdd rating
Critic-Aid Clear AF
generic name: miconazole
0 reviewsAdd rating
Cruex
generic name: undecylenic acid
0 reviewsAdd rating
Cruex Prescription Strength
generic name: miconazole
0 reviewsAdd rating
DermaFungal
generic name: miconazole
0 reviewsAdd rating
Desenex Antifungal Atheletes Foot Spray Liquid
generic name: miconazole
0 reviewsAdd rating
Desenex Antifungal Cream
generic name: clotrimazole
0 reviewsAdd rating
Desenex Antifungal Foot Cream
generic name: miconazole
0 reviewsAdd rating
Desenex Jock Itch
generic name: miconazole
0 reviewsAdd rating
Ecoza (Pro)
generic name: econazole
0 reviewsAdd rating
Elon Dual Defense Anti-Fungal Formula
generic name: undecylenic acid
0 reviewsAdd rating
Exelderm (Pro)
generic name: sulconazole
0 reviewsAdd rating
Exoderm
generic name: salicylic acid / sodium thiosulfate
0 reviewsAdd rating
Fungi-Guard
generic name: tolnaftate
0 reviewsAdd rating
FungiCURE Pump Spray
generic name: clotrimazole
0 reviewsAdd rating
Fungoid
generic name: miconazole
0 reviewsAdd rating
Ketodan (Pro)
generic name: ketoconazole
0 reviewsAdd rating
Kuric
generic name: ketoconazole
0 reviewsAdd rating
Lamisil AF Defense
generic name: tolnaftate
0 reviewsAdd rating
Lamisil AT Cream
generic name: terbinafine
0 reviewsAdd rating
Lamisil AT Cream for Jock Itch (Pro)
generic name: terbinafine
0 reviewsAdd rating
Lamisil AT Spray (Pro)
generic name: terbinafine
0 reviewsAdd rating
Loprox TS
generic name: ciclopirox
0 reviewsAdd rating
Lotrimin AF Athlete's Foot Cream
generic name: clotrimazole
0 reviewsAdd rating
Lotrimin AF Deodorant Powder Spray
generic name: miconazole
0 reviewsAdd rating
Lotrimin AF Jock Itch Powder Spray
generic name: miconazole
0 reviewsAdd rating
Lotrimin Ultra Athlete's Foot Cream
generic name: butenafine
0 reviewsAdd rating
Luzu (Pro)
generic name: luliconazole
0 reviewsAdd rating
Mentax (Pro)
generic name: butenafine
0 reviewsAdd rating
Micaderm
generic name: miconazole
0 reviewsAdd rating
Micatin
generic name: miconazole
0 reviewsAdd rating
Micro-Guard
generic name: miconazole
0 reviewsAdd rating
Miranel AF
generic name: miconazole
0 reviewsAdd rating
Mitrazol
generic name: miconazole
0 reviewsAdd rating
Monistat-Derm (Pro)
generic name: miconazole
0 reviewsAdd rating
Mycelex (Pro)
generic name: clotrimazole
0 reviewsAdd rating
Mycocide NS
generic name: tolnaftate
0 reviewsAdd rating
Myco Nail A
generic name: undecylenic acid
0 reviewsAdd rating
Naftin-MP
generic name: naftifine
0 reviewsAdd rating
NuZole
generic name: miconazole
0 reviewsAdd rating
Nyata
generic name: nystatin
0 reviewsAdd rating
Ony-Clear
generic name: miconazole
0 reviewsAdd rating
Pediaderm AF (Pro)
generic name: nystatin
0 reviewsAdd rating
Podactin
generic name: tolnaftate
0 reviewsAdd rating
Q-Naftate
generic name: tolnaftate
0 reviewsAdd rating
Rash Relief Antifungal
generic name: miconazole / zinc oxide
0 reviewsAdd rating
Secura Antifungal
generic name: miconazole
0 reviewsAdd rating
Secura Antifungal Extra Thick
generic name: miconazole
0 reviewsAdd rating
Soothe & Cool Inzo
generic name: miconazole
0 reviewsAdd rating
Tetterine
generic name: miconazole
0 reviewsAdd rating
Tinactin Jock Itch
generic name: tolnaftate
0 reviewsAdd rating
Tinaderm
generic name: tolnaftate
0 reviewsAdd rating
Tinamar
generic name: tolnaftate
0 reviewsAdd rating
Tinaspore
generic name: tolnaftate
0 reviewsAdd rating
Ting
generic name: tolnaftate
0 reviewsAdd rating
Triple Paste AF
generic name: miconazole
0 reviewsAdd rating
Undelenic
generic name: undecylenic acid
0 reviewsAdd rating
Versiclear
generic name: salicylic acid / sodium thiosulfate
0 reviewsAdd rating

Further information

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

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