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Topical Antifungal
Aka: Topical Antifungal, Antifungal Agents for Superficial Skin Infections
- Indications
- Cutaneous Fungal Infections (i.e. Tinea Corporis, Tinea Cruris, Tinea Pedis)
- Cutaneous Candidiasis (e.g. Intertrigo)
- Vulvovaginal Candidiasis
- Contraindications (due to lack of efficacy; these require systemic Antifungals)
- Tinea Unguium
- Tinea Capitis
- Precautions
- Start with narrower spectrum Topical Antifungals
- See protocol below
- Advance to more potent Antifungals as indicated for refractory course
- Avoid using high-potency Topical Antifungal-Corticosteroid combination agents (e.g. Lotrisone)
- Potent Corticosteroids may reduce the efficacy of the Antifungal
- Potent Topical Corticosteroids risk significant local adverse effects
- Technique
- Apply Topical Antifungals to an area encompassing the affected skin area
- Application should extend beyond the affected margin by at least 1 inch
- Apply the Topical Antifungals consistently for 1-6 weeks
- Continue topical agents for 1 week beyond the time the lesions appear to heal
- If Corticosteroid is indicated for concurrent inflammation
- Apply low dose Topical Corticosteroid (e.g. Hydrocortisone OTC) between doses of Topical Antifungal
- See precaution above above avoiding potent Topical Corticosteroids (especially in combination agents)
- Preparations: Older, narrow spectrum fungistatic agents
- Tolnaftate (Tinactin, OTC)
- Narrow spectrum with no effect on candida species
- Fungistatic for dermatophytes and Tinea Versicolor
- Haloprogin (Halotex)
- Similar to Tolnaftate with added candida coverage
- Increased risk of irritant dermatitis
- Preparations: First-line topical fungicidal agents
- Polyene Topical Antifungal (for Cutaneous Candidiasis)
- Nystatin
- Imidazole Topical Antifungal (broader spectrum for Tinea Infection and Cutaneous Candidiasis)
- Clotrimazole (Lotrimin, OTC)
- Miconazole (Micatin, OTC)
- Econazole (Spectazole)
- Ketoconazole (Nizoral)
- Oxiconazole (Oxistat)
- Sulconazole (Exelderm)
- Preparations: Second line topical fungicidal agents for refractory Tinea Infection
- Cost effective OTC agents ($16 for 30 grams in 2014)
- Terbinafine (Lamisil AT)
- Butenafine (Mentax, Lotrimin Ultra)
- Similar to allylamines
- Highly effective fungicidal agent
- Other agents
- Ciclopirox (Loprox, Penlac)
- Naftifine (Naftin)
- Luliconazole (Luzu)
- Not recommended as cost is nearly $400 for 60 grams (in 2014)
- Niche appears to be the convenience of once daily dosing
- References
- (2014) Presc Lett 21(5): 28
- Protocol
- See Vulvovaginal Candidiasis
- Cutaneous Candidiasis Management
- Polyene (e.g. Nystatin)
- Imidazoles (e.g. Clotrimazole)
- Dermatophyte Infections (e.g. Tinea Corporis)
- Imidazoles (e.g. Clotrimazole)
- Refractory Dermatophyte Infections
- Allylamines (e.g. Naftin, Lamisil)
- References
- Gupta (1998) Drugs 55:645-74 [PubMed]
- Weinstein (2002) Am Fam Physician 65(10):2095-102 [PubMed]