What is the treatment for a fungal infection in the armpit?

Treatment for Fungal Infection in Armpit

For fungal infections in the armpit, topical antifungal agents such as clotrimazole 1% cream applied twice daily for 1-2 weeks are the first-line treatment. 1

First-Line Treatment Options

Topical Antifungal Agents

• Azole drugs (fungistatic agents):

  • Clotrimazole 1% cream: Apply twice daily for 7-14 days 2, 1
  • Miconazole 2% cream: Apply twice daily for 7 days 2
  • Ketoconazole 2% cream: Apply once or twice daily for 7-14 days 1

• Allylamine drugs (fungicidal agents - often preferred for dermatophyte infections):

  • Terbinafine 1% cream: Apply once or twice daily for 7 days 1
  • Naftifine cream: Apply once or twice daily for 7-14 days 1
  • Butenafine cream: Apply once daily for 7 days 1

Application Technique

• Clean and dry the affected area thoroughly before application
• Apply a thin layer of the antifungal cream to the affected area and surrounding 1-2 cm of normal skin
• Continue treatment for the full prescribed duration, even if symptoms improve earlier 2

Treatment Selection Considerations

Type of Fungal Infection

• For dermatophyte infections (tinea corporis/cruris affecting the armpit): Allylamine drugs like terbinafine are often preferred as they are fungicidal and may require shorter treatment duration 1
• For yeast infections (Candida): Azole drugs like clotrimazole or miconazole are generally more effective 1

Severity Assessment

• Mild to moderate infection: Topical therapy alone is usually sufficient 2, 1
• Extensive or severe infection: Consider oral antifungal therapy (see below) 3

Oral Therapy for Resistant or Extensive Infections

If topical therapy fails or the infection is extensive, consider oral antifungal therapy:

• Fluconazole: 150 mg once weekly for 2-3 weeks 3
• Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 7 days 3
• Terbinafine: 250 mg daily for 1-2 weeks (for dermatophyte infections) 3

Adjunctive Measures

• Keep the affected area clean and dry
• Wear loose-fitting clothing made of breathable fabrics
• Change clothes, especially undergarments, daily
• Use separate towels and washcloths for the affected area
• For recurrent infections, consider using antifungal powders to keep the area dry 2, 4

Treatment Duration and Follow-up

• Continue treatment for at least 7-14 days, even if symptoms resolve earlier 2
• If no improvement after 2 weeks of appropriate therapy, reassess the diagnosis
• For recurrent infections, consider longer treatment courses and preventive measures 4

Common Pitfalls to Avoid

• Inadequate treatment duration: Stopping treatment once symptoms improve can lead to recurrence
• Concurrent use of corticosteroids: Avoid topical steroids as they can worsen fungal infections
• Poor hygiene: Failing to keep the area clean and dry can perpetuate the infection
• Misdiagnosis: Bacterial infections, contact dermatitis, or other skin conditions may mimic fungal infections 4

For persistent or recurrent infections despite appropriate therapy, consider obtaining a skin scraping for culture and sensitivity testing to confirm the diagnosis and guide targeted therapy.