From the Guidelines
Topical antifungal treatments are effective for managing vulvovaginal candidiasis (VVC), and I recommend starting with over-the-counter azole medications such as clotrimazole or miconazole cream, applied intravaginally for 3-7 days. For uncomplicated VVC, which accounts for about 90% of cases, treatment with a single dose of fluconazole or short-course fluconazole for 3 days can achieve >90% response 1. Some key points to consider when treating VVC include:
- Confirming the diagnosis with a wet-mount preparation and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae, and a normal pH (4.0–4.5) 1
- Using topical antifungal agents for 5–7 days for complicated VVC, or oral fluconazole 150 mg every 72 hours for 3 doses 1
- Considering treatment with boric acid, nystatin, or topical 17% flucytosine cream for C. glabrata VVC, which can be problematic to treat with azole therapy 1
- Starting with induction therapy with a topical agent or oral fluconazole for 10–14 days, followed by a maintenance azole regimen for at least 6 months for recurrent VVC 1 It's also important to note that treatment of VVC should not differ based on HIV infection status, and identical response rates are anticipated for HIV-positive and HIV-negative women 1. If symptoms worsen or don't improve after treatment, a prescription-strength antifungal or oral medication may be needed. Overall, the goal of treatment is to alleviate symptoms, prevent recurrence, and improve quality of life for patients with VVC.
From the FDA Drug Label
The chemical name for ciclopirox is 6-cyclohexyl-1-hydroxy-4-methyl-2(1H)-pyridone, with the molecular formula C12H17NO2 and a molecular weight of 207.27. Ciclopirox Topical Solution, 8%, (Nail Lacquer), as a component of a comprehensive management program, is indicated as topical treatment in immunocompetent patients with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum
Topical Anti-Fungus Treatment: Ciclopirox Topical Solution, 8%, (Nail Lacquer) is a topical treatment for mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum 2 2.
- Key Points:
- Indicated for immunocompetent patients
- Part of a comprehensive management program
- Includes removal of unattached, infected nails by a healthcare professional
- Not recommended for concomitant use with systemic antifungal agents for onychomycosis
- Should be used only under medical supervision
From the Research
Topical Anti-Fungus Treatment Options
- Topical antifungal agents are available for the treatment of superficial cutaneous fungal infections (SCFIs), including polyenes, imidazoles, allylamines, benzylamines, and hydroxypyridones 3.
- The two major classes of topical antifungal agents are azoles and allylamines, with allylamines being superior to azoles in activity against dermatophytes 3.
- Naftifine, a topical allylamine, is fungicidal in vitro against a wide spectrum of dermatophyte fungi and has been shown to be highly effective against various cutaneous dermatophyte infections 3.
Mechanisms of Action
- Azole drugs, such as miconazole and clotrimazole, are fungistatic, limiting fungal growth but depending on epidermal turnover to shed the still-living fungus from the skin surface 4.
- Allylamines and benzylamines, such as terbinafine and naftifine, are fungicidal, actually killing the fungal organisms 4.
- Fungicidal drugs are often preferred over fungistatic drugs for treatment of dermatophytic fungal infections, as they can achieve high cure rates with shorter treatment times 4.
Treatment Considerations
- Topical therapy is generally successful for common superficial tinea infections, unless the infection covers an extensive area or is resistant to initial therapy 5.
- Treatment should continue for at least one week after clinical clearing of infection, and newer medications may require fewer applications and a shorter duration of use 5.
- The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent 5.
Novel Delivery Systems
- Novel delivery carriers, such as nanoparticulate and vesicular carriers, have been developed to improve the delivery of antifungal drugs and enhance treatment outcomes 6.
- These carriers can facilitate the delivery of antifungal drugs across the skin, minimizing systemic side effects and improving patient compliance 6.
Specific Treatments
- Efinaconazole and tavaborole are topical antifungal agents that have been approved for the treatment of onychomycosis, providing an alternative to systemic antifungals 7.
- Naftifine 2% cream has been shown to be effective in treating cutaneous dermatophyte infections, with a clinically relevant therapeutic reservoir effect after completion of therapy 3.