From the Guidelines
Terbinafine 1% cream is the most effective topical antifungal for treating fungal skin infections, with a mycological cure rate of approximately 94% when applied daily for 1 week. When considering treatment options for fungal skin infections, several factors come into play, including the type of fungus, the severity of the infection, and the patient's overall health.
- The treatment should be applied to clean, dry skin, extending slightly beyond the affected area.
- It is essential to continue treatment for the full recommended duration, even if symptoms improve earlier, to prevent recurrence.
- For most common fungal infections, such as T cruris, terbinafine 1% cream has been shown to be effective, as noted in a study published in Pediatrics 1. Some other options, like butenafine and clotrimazole, are also available, but their effectiveness and approval vary depending on the patient's age and the specific infection being treated, as seen in the same study 1.
- Butenafine is only approved for adults, while terbinafine is approved for children 12 years and older.
- Clotrimazole is another alternative, but its application schedule differs, with twice weekly application for 4 weeks. It is crucial to follow the recommended treatment guidelines and consult a healthcare provider if the infection does not improve after two weeks of treatment or if it shows signs of bacterial infection, such as increased pain, warmth, or swelling.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Clotrimazole is a broad-spectrum antifungal agent that is used for the treatment of dermal infections caused by various species of pathogenic dermatophytes, yeasts, and Malassezia furfur. INDICATIONS AND USAGE Clotrimazole Cream is indicated for the topical treatment of candidiasis due to Candida albicans and tinea versicolor due to Malassezia furfur.
Clotrimazole is a suitable topical antifungal cream for treating fungal skin infections, including:
- Candidiasis due to Candida albicans
- Tinea versicolor due to Malassezia furfur
- Tinea pedis, tinea cruris, and tinea corporis due to Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, and Microsporum canis 2 2
From the Research
Topical Antifungal Creams
- Topical antifungal creams are effective in treating fungal skin infections by penetrating into the stratum corneum to kill or inhibit the growth of fungi 3.
- Azole drugs such as miconazole, clotrimazole, and ketoconazole are fungistatic, while allylamines and benzylamines such as terbinafine, naftifine, and butenafine are fungicidal 3.
Comparison of Antifungal Creams
- A study comparing terbinafine 1% cream and clotrimazole 1% cream found that terbinafine was more effective in treating tinea pedis, with a mycological cure rate of 93.5% compared to 73.1% for clotrimazole 4.
- Terbinafine 1% cream applied for 1 week was also found to be more effective than clotrimazole 1% cream applied for 4 weeks in terms of effective treatment rates 4.
Treatment of Specific Fungal Infections
- Yeast infections such as those caused by Candida albicans respond less well to allylamine drugs, and azole drugs are often preferred for these types of infections 3.
- Nail infections are difficult to cure with topical therapies, and systemic treatments are often required 3, 5.
- Oral antifungal agents such as fluconazole, itraconazole, and terbinafine can be effective in treating superficial fungal infections of the skin, including pityriasis versicolor, tinea corporis/cruris, and tinea pedis 6.
Choice of Antifungal Cream
- The choice of antifungal cream depends on the type of fungal infection, the severity of the infection, and the patient's preference 3.
- Cost is also a factor in choosing an antifungal cream, especially for large areas of the body surface 3.
- Newer antifungal agents have demonstrated significant therapeutic benefits and have broadened clinicians' choices in the treatment of superficial and systemic invasive fungal infections 5.