From the Guidelines
Ciclopirox is most effectively used as a 0.77% cream or gel applied twice daily to the affected areas for 4 weeks, as evidenced by its superiority to 1% clotrimazole cream or ciclopirox vehicle in achieving both clinical and mycological cure in the treatment of T pedis 1.
Topical Formulations and Applications
The most common preparations of ciclopirox include:
- Ciclopirox 1% cream, lotion, or gel for skin infections, applied twice daily for 2-4 weeks
- Ciclopirox 0.77% gel or suspension for scalp seborrheic dermatitis, applied twice daily for 4 weeks
- Ciclopirox 8% nail lacquer (Penlac) for onychomycosis, applied daily to affected nails for up to 48 weeks When using the nail lacquer, patients should apply it to the entire nail plate and 5mm of surrounding skin, allow it to dry for 30 seconds, and remove accumulated lacquer with alcohol once weekly.
Mechanism of Action and Efficacy
Ciclopirox works by inhibiting metal-dependent enzymes in fungi, disrupting cell membrane integrity and inhibiting fungal growth 1. It has broad-spectrum activity against dermatophytes, yeasts, and some molds. According to the British Association of Dermatologists' guidelines, ciclopirox is a useful treatment option for superficial and distal onychomycosis, and for patients in whom systemic therapy is contraindicated 1.
Side Effects and Precautions
Side effects of ciclopirox are generally mild and include local irritation, burning, or redness at the application site. Periungual and nail fold erythema are the most common side-effects associated with the use of ciclopirox 8% nail lacquer 1. For best results, patients should continue treatment for the full prescribed duration even if symptoms improve earlier, and maintain good hygiene practices to prevent reinfection.
From the FDA Drug Label
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 The comprehensive management program includes removal of the unattached, infected nails as frequently as monthly, by a health care professional who has special competence in the diagnosis and treatment of nail disorders, including minor nail procedures. Ciclopirox Topical Solution, 8%, (Nail Lacquer), should be used only under medical supervision as described above.
The topical medication for ciclopirox is Ciclopirox Topical Solution, 8%, (Nail Lacquer), which is used for the treatment of mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum. The treatment should be used as part of a comprehensive management program that includes removal of the unattached, infected nails as frequently as monthly, by a health care professional 2.
From the Research
Topical Medications for Ciclopirox
- Ciclopirox is a broad-spectrum antifungal agent that also exhibits anti-inflammatory and antibacterial activity 3
- The lotion and cream formulations of ciclopirox are effective in many types of infection, including tinea corporis/cruris, tinea pedis, cutaneous candidiasis, pityriasis (tinea) versicolor, and seborrheic dermatitis 3
- A ciclopirox gel 0.77% formulation is also indicated for the treatment of seborrheic dermatitis of the scalp, interdigital tinea pedis and tinea corporis 3
Comparison with Other Treatments
- Ciclopirox olamine cream 1% has been shown to be as effective in the treatment of inflamed, superficial fungal infections as a formulation in which ciclopirox 1% and hydrocortisone acetate 1% were combined 4
- Poloxamer 407-based formulations containing ciclopirox olamine proved to be about as effective as similar terbinafine hydrochloride systems in inhibiting the growth of Trichophyton rubrum 5
- Combining terbinafine with amorolfine tended to be more effective than terbinafine in conjunction with ciclopirox in treating onychomycosis 6
Treatment of Specific Conditions
- Ciclopirox is not indicated for the treatment of tinea unguium (onychomycosis) except as a topical antifungal agent 7
- Oral terbinafine is a useful agent for the treatment of tinea infections in immunocompromised patients due to its relatively low potential for drug-drug interactions 7
- Combined therapy with topical amorolfine and oral terbinafine is justified for the treatment of onychomycosis, particularly if the pathogen is a non-dermatophyte fungus such as Scopulariopsis brevicaulis 6