From the FDA Drug Label
The frequency of adverse events reported in patients using nystatin topical preparations is less than 0.1%. The more common events that were reported include allergic reactions, burning, itching, rash, eczema, and pain on application.
- Skin peeling is not explicitly mentioned as an adverse event in the drug label.
- The label does mention allergic reactions and rash, which could potentially be related to skin peeling.
- However, without direct information on skin peeling, it is unclear if nystatin can cause this specific side effect or if skin peeling is concerning for a drug reaction in patients with moderate to severe skin fungal infections 1.
From the Research
Nystatin can cause skin peeling as part of the healing process in treating moderate to severe skin fungal infections, but excessive peeling, especially with severe symptoms, may indicate a drug reaction. When treating fungal skin infections, nystatin disrupts the fungal cell membrane, leading to natural skin shedding or peeling as the infected skin heals and regenerates 2. This peeling is often accompanied by improvement in other symptoms like reduced redness, itching, and clearing of the infection. However, excessive peeling, especially when accompanied by severe itching, burning, rash, hives, swelling, or systemic symptoms like fever, should raise concern for a possible allergic reaction to nystatin. Some key points to consider:
- Nystatin is typically applied topically 2-3 times daily for 1-2 weeks, and treatment should continue for at least 48 hours after symptoms resolve to prevent recurrence.
- The distinction between normal healing and a drug reaction often depends on the timing, extent, and accompanying symptoms of the skin peeling.
- Clotrimazole, nystatin, and miconazole have demonstrated similar efficacy with complete cure rates of 73%-100% in treating cutaneous candidiasis, with nystatin being a suitable option for yeast infections of the skin and mucous membranes 3, 2. It is essential to monitor the patient's response to nystatin treatment and adjust the treatment plan as needed to minimize the risk of adverse reactions and ensure effective management of the fungal infection.