What Are Topical Antifungals?
Topical antifungals are medicines applied locally on the skin surface, scalp, and nails to treat fungal infections. These are the most preferred treatment for fungal infections as it is more target-specific and has fewer side effects. This ensures site-specific delivery of the medicine and less systemic toxicity. Some of the other advantages of topical antifungals over other routes of administration are patient compliance, increased efficacy of the medicine, and improved bioavailability.
Dermatophytes, yeasts, or molds cause the most common fungal infections. Topical antifungals work in two ways:
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They kill the fungal cells by destroying the cell membrane.
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They inhibit the growth and reproduction of fungal cells.
Antifungals like Amphotericin bind with the fungi and create holes in the cell membrane leading to cell lysis and death. Miconazole destabilizes the fungi's cell membrane, causing cell content leakage, lysis, and death.
Topical antifungals are available as creams, gels, lotions, powders, sprays, shampoos, or lacquers and can be taken as over-the-counter drugs. Nystatin is the only approved swish and swallows topical and oral antifungals. However, long-term use can cause severe side effects like Stevens-Johnsons syndrome.
How Are the Topical Antifungals Used?
Antifungals can be applied on the infected surface of the scalp, skin, nails, and vagina as directed by the doctor.
Different forms of topical antifungals and their ways of applications are::
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Creams and Gels - These are used to treat fungal skin infections. Apply a thin layer to the affected area in a circular motion once or twice a day, as directed by the doctor.
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Liquids - They are used for infected nails, and web spaces between the fingers. The undiluted liquid is painted on the affected area and allowed to dry. It is then rinsed thoroughly with water.
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Pessaries or Vaginal Tablets - These tablets treat fungal infections like thrush in the vagina. It is advised to follow the instructions in the pack or use it as directed by the doctor.
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Powders - Powders are dusted in between the toes and groin. The affected area should be dried before using it.
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Shampoos - Antifungal shampoo helps to treat scalp infections and is applied as directed by the doctor.
Antifungals may be used in combination with a topical steroid, such as Hydrocortisone, to treat rashes and inflammation caused by infections.
What Are the Dosages of Topical Antifungals?
The dose of topical antifungals will vary with different patients and their medical problems. For which the drug is being used. It is important to complete the full treatment, even if the symptoms begin to clear after a few days. If you stop using the medicine too soon, the symptoms may return.
What Are More Effective Oral or Topical Antifungals?
Oral antifungal therapy is quicker and more effective than topical antifungals. They may be taken in lesions like candidiasis or Pityriasis Versicolor, which are more extensive and resistant to topical therapy.
The advantage of topical antifungals over oral antifungals mainly includes limited system absorption, ease of use, low incidences of drug interactions, and comparatively low cost. The topical antifungals can be prescribed with antibacterials for better results.
What Are Topical Antifungals Used For?
Topical antifungals are used to treat the following conditions:
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Tinea cruris (infection around the groin).
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Rhinosinusitis (sinus infection).
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Athlete’s foot.
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Vaginal candidiasis.
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Paronychia (infection around the nail).
Most Commonly Prescribed Topical Antifungals:
The most commonly used antifungals are Nystatin and Miconazole. The other commonly prescribed topical antifungals are
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Econazole.
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Ketoconazole.
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Terbinafine.
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Amphotericin B.
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Terconazole
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Sulconazole.
Precautions And Warnings:
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Hypersensitivity - Formulations containing Amphotericin B, and Azoles are contraindicated in patients with known hypersensitivity to these drugs.
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Hepatic and Renal Toxicity - Ketoconazole carries the risk of hepatotoxicity and is contraindicated in patients with hepatic dysfunction. Antifungals like Amphotericin B can cause extensive nephrotoxicity.
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Pregnant and Lactating Women - Careful consideration of the benefits to the mother and risk to the fetus is required when prescribing antifungal therapy.
Tell your doctor your medical and drug history. Also, if you are pregnant or planning pregnancy, inform your doctor.
How Long Do You Need to Take Antifungals?
Topical antifungals need to be applied twice a day for four to six weeks or per the doctor’s advice. The treatment may vary as some fungal infections may take months to treat while others may take years. Fungal infections like athlete’s foot or ringworm infections take a minimum of two weeks when treated with cream.
Missed Dose:
You can apply the missed dose that you remember. You should not use extra medicine at one time.
Side Effects of Antifungals:
The side effects may depend on the type of the drug as well as the dosage. Common side effects are
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Skin irritation.
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Burning or stinging.
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Edema.
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Tenderness.
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Redness.
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Dryness of scalp.
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Severe allergic reactions in the skin.
Is Topical Antifungal Safe for Children?
Many topical antifungals are used to treat infections in children. Doses are different in different age groups. Consult your doctor to decide on the dosage.
Are Topical Antifungals Safe in Pregnant and Lactating Women?
They are generally safe for pregnant women if taken for a short duration. However, careful consideration of risks and benefits is required. In breastfeeding mothers, care should be taken to avoid the baby’s contact with the treated area. Some medications like Lamisil are best avoided as it enters the breast milk.
Can We Use Antifungal and Antibacterial Cream Together?
A combination of antifungal and antibacterial medicines is very effective and can be used for multidrug-resistant infections like Candida Auris. Antifungal creams or suppositories help to prevent yeast infections caused by antibiotics.
Conclusion:
Fungal infections continue to be a growing threat to human health. Early detection and optimal management is the best approach. These infections can be very uncomfortable, painful, and embarrassing at times. Antifungal medications treat fungal infections affecting the skin, scalp, nails, and sometimes organs. Inappropriate and irrational use of topical antifungal therapy can cause drug resistance and should be discouraged. The use of combination drug therapy and appropriate dosing can avoid drug resistance. It is advisable to see a doctor if you have a fungal infection. Do not use topical antifungals for the long term without consulting your doctor. The doctor may recommend your diet and lifestyle changes to prevent fungal infections.
