Latest Drugs, Latest Approval in 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
clotrimazole FungiCURE, Lotrimin
econazole Ecoza, Spectazole
ketoconazole Nizoral topical
miconazole Azolen, Zeasorb
miconazole/zinc oxide Rash Relief Antifungal, Vusion
oxiconazole Oxistat
sertaconazole Ertaczo
tioconazole 1-day, Vagistat-1
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.

Name Updated
Fungi-nail pen (Undecylenic acid topical [ un-deh-si-len-ik-as-id ]) 21-Aug-2023
Lotrimin jock itch powder (Clotrimazole topical [ kloe-trim-a-zole ]) 17-Aug-2023
Ciclopirox topical (Ciclopirox topical [ sye-kloe-peer-ox-top-i-kal ]) 16-Aug-2023
Butenafine topical (Butenafine topical [ bue-ten-a-fine-top-i-kal ]) 16-Aug-2023
Ting af (Miconazole topical [ my-con-a-zole ]) 16-Aug-2023
Sulconazole topical (Sulconazole topical [ sul-kon-a-zole ]) 16-Aug-2023
Soothe and cool inzo (Miconazole topical [ my-con-a-zole ]) 16-Aug-2023
Remedy (Miconazole topical [ my-con-a-zole ]) 16-Aug-2023
Nuzole (Miconazole topical [ my-con-a-zole ]) 16-Aug-2023
Miconazole 7 (Miconazole vaginal [ my-caw-nah-zole ]) 16-Aug-2023
Miconazole 1 combination pack (Miconazole vaginal [ my-caw-nah-zole ]) 16-Aug-2023
Azolen (Miconazole topical [ my-con-a-zole ]) 15-Aug-2023
Anti-fungal liquid (Clotrimazole topical [ kloe-trim-a-zole ]) 15-Aug-2023
Soothe and cool inzo (Miconazole topical [ my-con-a-zole ]) 15-Aug-2023
Silka antifungal (Terbinafine topical [ ter-bin-a-feen-top-i-kal ]) 15-Aug-2023
Monistat 3 combination pack (Miconazole vaginal [ my-caw-nah-zole ]) 14-Aug-2023
Lotrimin af cream for ringworm (Clotrimazole topical [ kloe-trim-a-zole ]) 14-Aug-2023
Lagicam (Miconazole vaginal [ my-caw-nah-zole ]) 14-Aug-2023
Clotrimazole vaginal (Clotrimazole vaginal [ kloe-trim-a-zole ]) 14-Aug-2023
Clotrimazole topical (Clotrimazole topical [ kloe-trim-a-zole ]) 14-Aug-2023
Aloe vesta clear antifungal (Miconazole topical [ my-con-a-zole ]) 14-Aug-2023
Salicylic acid and sodium thiosulfate topical (Salicylic acid and sodium thiosulfate topical [ sal-i-sil-ik-as-id-and-soe-dee-um-thye-oh-sul-fate ]) 14-Aug-2023
Naftifine topical (Naftifine topical [ naf-ti-feen-top-ik-al ]) 14-Aug-2023
Miconazorbaf (Miconazole topical [ my-con-a-zole ]) 13-Aug-2023
Miconazole vaginal (Miconazole vaginal [ my-caw-nah-zole ]) 13-Aug-2023
Miconazole topical (Miconazole topical [ my-con-a-zole ]) 13-Aug-2023
Miconazole and zinc oxide topical (Miconazole and zinc oxide topical [ mye-kon-a-zole-and-zink-ox-ide-top-ik-al ]) 13-Aug-2023
Luliconazole topical (Luliconazole topical [ loo-li-kon-a-zol-top-i-kal ]) 13-Aug-2023
Efinaconazole topical (Efinaconazole topical [ ef-in-a-kon-a-zole-top-ik-al ]) 13-Aug-2023
Econazole topical (Econazole topical [ ee-con-a-zole ]) 13-Aug-2023
Econazole nitrate (Econazole topical [ ee-con-a-zole ]) 13-Aug-2023
Athlete's foot cream (Terbinafine topical [ ter-bin-a-feen-top-i-kal ]) 13-Aug-2023
Zeasorb-af jock itch (Miconazole topical [ my-con-a-zole ]) 12-Aug-2023
Undecylenic acid topical (Undecylenic acid topical [ un-deh-si-len-ik-as-id ]) 12-Aug-2023
Tolnaftate topical (Tolnaftate topical [ toll-naf-tate ]) 12-Aug-2023
Thera antifungal (Miconazole topical [ my-con-a-zole ]) 12-Aug-2023
Terbinafine topical (Terbinafine topical [ ter-bin-a-feen-top-i-kal ]) 12-Aug-2023
Tavaborole topical (Tavaborole topical [ ta-va-bor-ole-top-ik-al ]) 12-Aug-2023
Sertaconazole topical (Sertaconazole topical [ ser-ta-kon-a-zole ]) 12-Aug-2023
Secura antifungal greaseless (Miconazole topical [ my-con-a-zole ]) 12-Aug-2023
Remedy antifungal with olivamine (Miconazole topical [ my-con-a-zole ]) 12-Aug-2023
Remedy (miconazole) (Miconazole topical [ my-con-a-zole ]) 12-Aug-2023
Prescription strength cruex (Clotrimazole topical [ kloe-trim-a-zole ]) 12-Aug-2023
Oxiconazole topical (Oxiconazole topical [ oks-i-kon-a-zole ]) 11-Aug-2023
Nystatin topical (Nystatin topical [ nye-stat-in ]) 11-Aug-2023
Miconazole 3 (Miconazole vaginal [ my-caw-nah-zole ]) 11-Aug-2023
Fungoid (miconazole) (Miconazole topical [ my-con-a-zole ]) 11-Aug-2023
Secura antifungal extra thick (Miconazole topical [ my-con-a-zole ]) 07-Aug-2023
Lotrimin af powder spray (Miconazole topical [ my-con-a-zole ]) 07-Aug-2023
Lotrimin af jock itch (Clotrimazole topical [ kloe-trim-a-zole ]) 07-Aug-2023