From the Guidelines
For the treatment of vulvovaginal candidiasis, I recommend using a topical antifungal cream such as clotrimazole 1% or 2% cream, as it has been shown to be effective in achieving >90% response rates [ 1 ]. When it comes to treating fungal infections, particularly vulvovaginal candidiasis, it's essential to choose the right antifungal cream. The evidence suggests that topical antifungal agents are just as effective as oral formulations in treating uncomplicated vulvovaginal candidiasis [ 1 ]. Some key points to consider when using antifungal creams include:
- Applying a thin layer to the affected area and surrounding skin
- Using the cream for the recommended duration, typically 3-7 days for uncomplicated infections
- Keeping the affected area clean and dry to prevent fungal growth
- Considering prescription-strength options like ketoconazole 2% cream or ciclopirox 0.77% for severe or persistent infections
- Being aware that some Candida species, like C. glabrata, may require alternative treatments, such as boric acid or nystatin [ 1 ] It's also important to note that recurrent vulvovaginal candidiasis may require induction therapy with a topical agent or oral fluconazole, followed by a maintenance azole regimen for at least 6 months [ 1 ]. Overall, the choice of antifungal cream will depend on the specific type and severity of the infection, as well as the patient's individual needs and medical history.
From the FDA Drug Label
Ketoconazole Cream 2% is indicated for the topical treatment of tinea corporis, tinea cruris and tinea pedis caused by Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum; in the treatment of tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); in the treatment of cutaneous candidiasis caused by Candida spp. and in the treatment of seborrheic dermatitis. Terbinafine Hydrochloride Cream 1% Antifungal Cream
- Ketoconazole Cream 2% is an effective antifungal cream for the treatment of various fungal infections, including:
- Tinea corporis
- Tinea cruris
- Tinea pedis
- Tinea versicolor
- Cutaneous candidiasis
- Terbinafine Hydrochloride Cream 1% is also an antifungal cream, but the provided label does not specify the types of fungal infections it is effective against, except that it cures most athlete's foot 2 3
From the Research
Effective Antifungal Creams
- Terbinafine 1% cream is an effective antifungal cream, with a cure rate of 78% in patients with tinea pedis after a single application 4.
- Terbinafine 1% cream applied twice daily for 1 week was significantly superior to a 4-week course of clotrimazole 1% cream for treating tinea pedis 4, 5.
- Flutrimazole 1% dermal cream has good efficacy, similar to that of clotrimazole, and is well tolerated in the treatment of fungal infections of the skin 6.
- Naftifine, a topical allylamine, is fungicidal in vitro against a wide spectrum of dermatophyte fungi and has been shown to be highly effective against a variety of cutaneous dermatophyte infections 7.
Comparison of Antifungal Creams
- Terbinafine 1% cream is more effective than clotrimazole 1% cream in terms of mycological cure and effective treatment 5.
- Terbinafine 1% cream is at least as effective as miconazole 2% cream and naftifine 1% gel in tinea pedis, and more effective than clotrimazole 1% cream, bifonazole 1% cream, and oxiconazole 1% lotion 8.
- Naftifine 2% cream has a clinically relevant therapeutic reservoir effect after completion of therapy 7.
Treatment Duration and Efficacy
- Topical terbinafine 1% formulations are effective when applied once or twice daily for up to 2 weeks, achieving mycological cure in > 80% of patients with tinea pedis, tinea corporis/cruris, cutaneous candidiasis, and pityriasis versicolor 8.
- Terbinafine 1% cream applied twice daily for 1 week was more effective than clotrimazole 1% cream applied twice daily for 4 weeks in the treatment of tinea pedis 5.