Options for Treatment of Superficial Fungal Infections*
Medications | Formulations | Uses† |
|---|---|---|
Allylamines | ||
Amorolfine‡ | 5% solution | |
NaftifineNaftifine | 1% cream or gel | Dermatophytoses, skin candidiasis |
TerbinafineTerbinafine | Topical: 1% cream or solution | |
Oral: 250-mg tablet | ||
Benzylamine | ||
ButenafineButenafine | 1% cream | |
Imidazoles | ||
ButoconazoleButoconazole | 2% cream | |
ClotrimazoleClotrimazole | Topical: 1% cream, lotion, or solution; 100-, 200-, and 500-mg vaginal suppository tablets | Dermatophytoses, candidiasis (oropharyngeal, skin, vulvovaginal) |
Oral: 10-mg lozenges | ||
EconazoleEconazole | 1% cream | |
FluconazoleFluconazole | 50 and 200 mg/5 mL solution; 50-, 100-, 150-, and 200-mg tablets | Candidiasis (vulvovaginal, skin, oropharyngeal) |
ItraconazoleItraconazole | 100-mg capsules, 10 mg/mL solution | Tinea unguium, other onychomycoses |
KetoconazoleKetoconazole | 2% cream, 1 to 2% shampoo | Dermatophytoses, skin candidiasis |
MiconazoleMiconazole | 1 to 2% liquid (aerosol), 2% powder (aerosol), 1 to 2% cream and lotion, 1% solution, 2% powder or tincture, 100- or 200-mg vaginal suppositories | Dermatophytoses, candidiasis (skin, vulvovaginal) |
OxiconazoleOxiconazole | 1% cream or lotion | |
SulconazoleSulconazole | 1% cream or solution | |
TerconazoleTerconazole | 0.4% and 0.8% cream, 80-mg suppositories | |
TioconazoleTioconazole | 6.5% ointment | |
Polyene | ||
NystatinNystatin | Topical: 100,000 units/g cream, ointment, powder, or vaginal tablet | Candidiasis (oropharyngeal, skin) |
Oral: 100,000 units/mL suspension, 500,000-unit tablets | Candidiasis (oropharyngeal, gastrointestinal) | |
Miscellaneous | ||
Carbolfuchsin | Solution | Chronic dermatophytoses, intertrigo |
CiclopiroxCiclopirox | 0.77% gel, 8% lacquer solution | Dermatophytoses, candidiasis, tinea versicolor, onychomycosis |
Clioquinol¶ | 3% cream | |
Gentian violetGentian violet | 1 or 2% solution | Dermatophytoses, especially tinea pedis; sometimes candidiasis |
GriseofulvinGriseofulvin | 125-, 165-, 250-, 330-, and 500-mg tablets | |
TolnaftateTolnaftate | 1% liquid, powder, liquid or aerosol spray, cream, or solution | |
Zinc | ||
Undecylenate/undecylenate acid (undecylenic acid, undecylenate salts, zincundecate)Undecylenate/undecylenate acid (undecylenic acid, undecylenate salts, zincundecate) | 25% solution, 10% tincture | Superficial dermatophyte infections (eg, tinea pedis) |
* Advantages of one topical medication over another for most infections are not clear. For skin infections, allylamines have good activity against dermatophytes but weaker activity against Candida; imidazoles have better activity against both dermatophytes and Candida. Adverse effects are rare, but all topical antifungals can cause skin irritation, burning, and contact dermatitis. Doses may vary by indication. Oral antifungals can cause hepatitis and neutropenia. Periodic laboratory monitoring of hepatic function and of complete blood count is recommended when oral antifungals (eg, itraconazole, terbinafine) are given for Oral antifungals can cause hepatitis and neutropenia. Periodic laboratory monitoring of hepatic function and of complete blood count is recommended when oral antifungals (eg, itraconazole, terbinafine) are given for> 1 month. Oral itraconazole, terbinafine, and fluconazole are metabolized through the cytochrome P-450 enzyme system and thus have many potential drug interactions. Some interactions may be severe; cardiac arrhythmias are a risk for some people. Care should be taken to minimize the effects of interactions with these medications. Oral itraconazole, terbinafine, and fluconazole are metabolized through the cytochrome P-450 enzyme system and thus have many potential drug interactions. Some interactions may be severe; cardiac arrhythmias are a risk for some people. Care should be taken to minimize the effects of interactions with these medications. | ||
† Fungal pathogens include yeast (eg, Candida) and dermatophytes. | ||
‡ This medication is not available in the United States or Canada but is available elsewhere. | ||
¶ This medication is not available in the United States. | ||