From the Guidelines
Clotrimazole is generally preferred over nystatin for treating intertrigo due to its broader antifungal coverage and better skin penetration. Both nystatin and clotrimazole are effective for treating intertrigo, as stated in the guidelines for treatment of candidiasis 1. Clotrimazole 1% cream applied twice daily for 2-4 weeks typically provides better outcomes because it has broader antifungal coverage, treating both yeast and dermatophyte infections that commonly occur in intertrigo.
- Key benefits of clotrimazole include:
- Broader antifungal coverage
- Better skin penetration
- Less frequent application required
- Nystatin is effective specifically against Candida species but lacks activity against dermatophytes, making it less versatile. For severe cases or those with significant inflammation, combining the antifungal with a low-potency topical steroid (like hydrocortisone 1%) for the first week can help reduce inflammation and symptoms more quickly. Patients should be advised to keep the affected areas clean and dry, wear loose-fitting clothing, and use absorbent powders in skin folds to prevent recurrence. If bacterial superinfection is suspected, a combination product containing an antibacterial component may be necessary, as suggested by the practice guidelines for the treatment of candidiasis 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Nystatin and Clotrimazole in Intertrigo
- Both nystatin and clotrimazole are used to treat fungal lesions in intertrigo, with similar efficacy reported in various studies 2, 3, 4.
- Clotrimazole has been shown to be effective against a range of fungal infections, including Candida, Trichophyton, and Microsporum 3.
- Nystatin is also effective against Candida, and is often used to treat cutaneous candidiasis 2, 4.
- A review of topical and systemic treatments for cutaneous candidiasis found that clotrimazole, nystatin, and miconazole had similar efficacy, with complete cure rates of 73%-100% 4.
- There is no clear evidence to suggest that one is better than the other in the treatment of intertrigo, with both being recommended as treatment options 2, 4.
Treatment of Intertrigo
- Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation 5, 6.
- Treatment of intertrigo involves identifying and managing predisposing factors, educating patients in skin fold management, and using topical agents to treat secondary infections 5, 6.
- Moisture-wicking textiles and structured skin care routines can also help to reduce skin-on-skin friction and prevent secondary infections 5.
Efficacy of Clotrimazole and Nystatin
- Clotrimazole has been shown to be as effective as nystatin in the treatment of cutaneous candidiasis, with similar cure rates reported in various studies 3, 4.
- Nystatin is also effective against Candida, and is often used to treat cutaneous candidiasis 2, 4.
- Both clotrimazole and nystatin are well-tolerated, with mild adverse effects reported in some cases 3, 4.