Does terbinafine (antifungal medication) come in a topical formulation?

Terbinafine Topical Formulations for Fungal Infections

Yes, terbinafine is available in topical formulations, including 1% cream that has demonstrated high efficacy for dermatophyte infections with shorter treatment durations compared to other antifungal agents. 1

Available Topical Terbinafine Formulations

Terbinafine comes in several topical formulations:

• 1% cream - Most common formulation, applied once or twice daily 1, 2
• Film-forming solution (FFS) - A newer formulation allowing for single-dose treatment of tinea pedis 3
• Gel - Another topical application option 2

Clinical Applications of Topical Terbinafine

Tinea Pedis (Athlete's Foot)

• Highly effective with just 1 week of once-daily application 2
• Mycological cure rates of approximately 90% 4
• Superior to clotrimazole 1% cream applied twice daily for 4 weeks (93.5% vs 73.1% mycological cure rate) 5
• Can be used in film-forming solution as a single-dose treatment 3

Tinea Cruris (Jock Itch)

• 1% cream applied daily for 1 week has shown approximately 94% mycological cure rate 1
• Approved for children 12 years and older 1

Other Dermatophyte Infections

• Effective for tinea corporis (ringworm) with similar high cure rates 4
• Has shown efficacy in cutaneous candidiasis and pityriasis versicolor (approximately 80% cure rate) 4

Advantages of Topical Terbinafine

1. Shorter treatment duration: Effective with just 1 week of treatment compared to 2-4 weeks for other antifungals 2, 5
2. Fungicidal action: Unlike most antifungals which are fungistatic, terbinafine has fungicidal activity against dermatophytes 4, 3
3. High skin penetration: Forms a depot in the upper skin layer, allowing for sustained activity 2
4. Excellent safety profile: No significant difference in adverse events compared to placebo 2
5. Flexible application options: Various formulations and frequencies (once daily, twice daily, or even single application for FFS) 2, 3

Treatment Recommendations

For tinea pedis:

• Apply terbinafine 1% cream once daily for 1 week 2, 5
• Alternative: Film-forming solution as a single application for improved compliance 3

For tinea cruris:

• Apply terbinafine 1% cream once daily for 1 week 1

Important Considerations

• Topical terbinafine is well-tolerated with minimal side effects, similar to placebo in controlled studies 2
• Efficacy is consistent across different formulations and application frequencies 2
• For severe or extensive fungal infections, oral terbinafine may be more appropriate 6
• For onychomycosis (nail infections), topical treatments generally have limited efficacy compared to oral therapy, though newer topical formulations of terbinafine are being investigated 1, 7

Potential Pitfalls

• Topical therapy alone is not recommended for tinea capitis (scalp ringworm); oral therapy is generally indicated 1
• Topical treatments have limited efficacy for nail infections unless they are very superficial or early-stage 7
• Misdiagnosis of the fungal infection may lead to treatment failure; confirmation by microscopy and culture is ideal before initiating treatment