Topical antifungals: Uses, common brands, and safety info

Fungal skin infections are quite common because there are millions of different fungi that we may encounter in our everyday spaces. This puts many people at risk of developing fungal infections, which can occur anywhere in the body. Anyone who has experienced red, dry, scaly, or itchy skin has probably been infected by some type of fungus and as a result has likely tried a topical antifungal medication. 

Topical antifungals are a type of dermatological medication used to treat superficial fungal infections of the skin, hair, and nails. These medications are quite common and can be used in a variety of locations throughout the body. Most topical antifungal medications require a prescription from your healthcare provider, but there are also a few over-the-counter options available. The chart below provides some of the more common topical antifungal preparations available along with pricing and safety information.

*Available in prescription and OTC formulations

Other topical antifungals include:

• Canesten (bifonazole)

• Castellani Paint (phenol topical)

• Desenex (miconazole topical)

• Ertaczo (sertaconazole topical)

• Exelderm (sulconazole topical)

•  Fungi-Nail Anti-Fungal (tolnaftate topical)

• Fungi-Nail Anti-Fungal Pen (undecylenic acid topical)

• Fungicure Athlete’s Foot Cream (tolnaftate topical)

• Fungicure Intensive Pump Spray (clotrimazole topical)

• Fungicure Liquid Gel (clotrimazole topical)

• Fungicure Manicure & Pedicure (clotrimazole topical)

• Fungicure Maximum Strength Liquid (undecylenic acid topical)

• Fungoid Tincture (miconazole topical)

• Fungoid-D (tolnaftate topical)

• Gentian violet topical

• Lamisil AF Defense (tolnaftate topical)

• Lotrimin AF Powder (miconazole topical)

•  Lotrimin AF Spray (miconazole topical)

• Lotrimin AF Ultra (butenafine topical)

• Mentax (butenafine topical)

• Monistat-Derm (miconazole topical)

• Mycelex (clotrimazole topical)

• Mycolog-II (nystatin/triamcinolone)

• Pedi-Dri (nystatin topical)

• Penlac Nail Lacquer (ciclopirox topical)

• Selsun Blue 2-in-1 (selenium sulfide topical)

• Selsun Blue Medicated (selenium sulfide topical)

• Selsun Blue Moisturizing (selenium sulfide topical)

• Selsun Blue Full & Thick (pyrithione zinc topical)

• Selsun Blue Itchy Dry Scalp (pyrithione zinc topical)

• T/Gel Daily Control 2-in-1 Dandruff Shampoo Plus Conditioner (pyrithione zinc topical)

• Vagistat-1 (tioconazole topical)

• Vusion (miconazole/ zinc oxide/ petrolatum topical)

What are topical antifungals?

Topical antifungals are antimycotic agents used to kill or prevent fungal infections. Because fungal infections are quite common, many individuals (even those who are healthy) may experience a fungal infection. Luckily, superficial fungal infections are not life-threatening. This allows topical antifungals to be a useful and convenient treatment option for these types of infections. 

How do topical antifungals work?

Topical antifungals agents work by killing or preventing fungal organisms from living on the body. These medications target specific structures or functions only found in the cells of fungi and not humans. These structures are usually the cell wall and cell membrane that is used to protect fungi. Once these structures are compromised, the fungal cell no longer has protection and will die. As a result, the fungus can no longer cause harm to the human host.

What are topical antifungals used for?

Topical antifungal drugs are used to treat many common types of fungal infections including:

• Pityriasis

• Tinea capitis

• Tinea pedis

• Ringworm

• Cutaneous candidiasis

• Dandruff

• Diaper rash

• Yeast infections

• Seborrheic dermatitis

• Onychomycosis

• Intertrigo

• Paronychia

• Jock itch

• Tinea versicolor

• Tinea corporis

• Tinea cruris

Guidance from your healthcare provider should always be sought out to properly treat these types of conditions.

Types of topical antifungals

There are a variety of different types of topical antifungal agents including foams, ointments, creams, gels, solutions, sprays, shampoos, powders, lotions, sprays, and lacquers. Antifungals are used based on the type of fungal infection one is experiencing. These medications target either molds, yeast, or dermatophytes—all different forms of fungi. Some topical antifungals can be used to treat multiple types of fungi at once while others may be more specific for one type of fungus. 

Allylamine antifungals

The allylamines are a new type of antifungal drug that is highly selective for the fungal enzyme but have a minimal effect on humans. It interferes with sterol biosynthesis by inhibiting the enzyme squalene 2,3-epoxidase. This inhibition results in decreased amounts of sterols, causing cell death. The allylamines allow the active ingredients in the medication to accumulate well within the stratum corneum of the skin and nails. They are known to be quite effective against dermatophytes, yeast, and molds.

Examples of topical allylamines: Naftin, Lamisil

Azole antifungals

Azoles are a type of antifungal drug that contains an azole ring that stops the growth of multiple types of fungi. This occurs by blocking an enzyme in the fungal cell membrane resulting in its cell death. They are further separated into two groups with either two nitrogens (imidazoles) or three nitrogens (triazoles) in the azole ring. Topical antifungals are typically part of the imidazole group. Azole antifungals can be used for a variety of conditions such as athlete’s foot, vaginal yeast infections, ringworm, and fungal nail infections.

Examples of topical azoles: Lotrimin AF Cream, Ecoza, Xolegel, Luzu, Micatin

Benzoxaborole antifungals

Benzoxaborole antifungals are a newer class of antimycotic medications. They are known to block the ability of the fungus to produce proteins in a highly specific way by disrupting the action of yeast cytoplasmic enzymes involved in the translation process, which is called oxaborole tRNA trapping mechanism. Currently this antifungal is being used only for nail fungus.

Examples of topical benzoxaboroles: Kerydin

Ciclopirox olamine antifungals

Unlike many of the other antimycotic agents, ciclopirox olamine’s mechanism of action is poorly understood. However, many believe it is related to loss of function by altering certain enzymes disturbing DNA repair. This topical treatment can be used for athlete’s foot, ringworm, seborrheic dermatitis, and nail fungus.

Examples of topical ciclopirox olamine: Penlac Nail Lacquer, Ciclodan, Loprox

Polyene antifungals

These antifungals bind to the main sterol in the fungal cell membrane and cause depolarization of the membrane. This increases the membrane’s ability to absorb which results in fungal cell death. Polyenes do not work well orally so they are mostly seen as a solution or given intravenously as a systemic antifungal. An example of an intravenous antifungal is amphotericin B. These antifungal preparations are also not suitable for dermatophyte fungal infections.

Examples of topical polyenes: Mycostatin, Nyamyc, Nystop

Thiocarbamate antifungals

Thiocarbamates are antifungals used for mild to moderate, superficial dermatophyte infections of the skin and nails. It is supplied as a cream, powder, spray, and liquid aerosol. Generally, this mediation does not work well against yeasts. Common uses of these topical treatments include jock itch, athlete’s foot, and ringworm. The exact mechanism of action for this antifungal is unknown but it is believed they block sterol synthesis within the fungus inhibiting its growth. Examples of topical thiocarbamates: Tinactin, Tinaderm, Tinaspore

Undecylenic alkanolamide antifungals

These antifungal preparations are a type of unsaturated fatty acid that prevents the growth of fungus on the skin. Treatment with this medication is only for the skin and is mostly used for ringworm, athlete’s foot, and jock itch. It is not suitable for fungal infections of the scalp and nails. These antifungals can be found in cream, solution, powder, and tincture forms.

Examples of topical undecylenic alkanolamides: Fungicure Maximum Strength Liquid, Fungi-Nail Anti-Fungal Pen

Who can take topical antifungals?

Adult men, women, seniors, and children are all safe to use topical antifungals. An example of a topical antifungal used in infants is miconazole gel for oral thrush. Different dosages may be required for children of different age groups so please discuss the medication with your pharmacist or healthcare provider prior to using any topical antifungal preparations.

If there are known reactions to active ingredients in these types of medications, they should be avoided until further discussion can be had with your pharmacist or healthcare provider regarding the benefits versus the risks of taking the drug. Sometimes an alternative form may be available.

Are topical antifungals safe?

Typically, topical antifungal therapy is very safe and has a variety of application options available. There are no serious contraindications for use of these medications. However, patients who may be on a blood thinner, long-term steroids, anticonvulsants or are diabetic or have a weakened immune system should review its safety with their healthcare provider prior to applying. It is also important when using these medications that they are only applied to the lesions or affected area to prevent irritation to the surrounding healthy skin.

Topical antifungal restrictions

 Do not take topical antifungals if you have:

• Known hypersensitivity to medication

• A skin infection where the medication would be applied

Can you take topical antifungals while pregnant or breastfeeding?

Topical antifungals are safe to use while pregnant or breastfeeding. It is recommended that the medication is not applied directly on the breast or nipple while breastfeeding.

Are topical antifungals controlled substances?

Because topical antifungals are not habit-forming and do not pose any risk of dependency to the medication, they are NOT controlled substances.

Common topical antifungals side effects

Although there are various side effects associated with the use of topical antifungals, they are all minor and not life-threatening. The most common side effects include:

• Itching

• Burning

• Rash

• Redness

• Abdominal pain

• Diarrhea

• Tingling

• Skin irritation

• Thinning of skin

• Hypopigmentation

• Maceration of skin

• Bruising

• Alopecia

• Hair discoloration

• Stinging

• Dryness

• Ingrown toenail 

How much do topical antifungals cost?

The cost for topical antifungals can vary significantly. Without health insurance, some topical preparations may be as low as $12 while others may be as much as $2,000. Luckily, most of these medications come in the form of a generic, which lowers the costs and out-of-pocket responsibility for customers. Currently, the newer topical antifungals on the market, Jublia and Kerydin do not have a generic and are the most expensive topical antifungals. 

A coupon from SingleCare can bring down the costs tremendously for any prescription— regardless of your health insurance status.