From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis and tinea (pityriasis) versicolor: It is recommended that Ketoconazole Cream 2% be applied once daily to cover the affected and immediate surrounding area INDICATIONS & USAGE SECTION 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.
The treatment approach for a fungal skin infection using ketoconazole (antifungal) 2% is to apply the cream once daily to the affected and surrounding area. The duration of treatment varies depending on the type of infection:
- Two weeks for candidal infections, tinea cruris, and corporis
- Two weeks for tinea versicolor
- Six weeks for tinea pedis
- Four weeks or until clinical clearing for seborrheic dermatitis There is no information in the provided drug labels about the use of prednisone (corticosteroid) 50 milligrams for the treatment of fungal skin infections 1 1.
From the Research
Ketoconazole 2% cream and prednisone 50 mg should not be used together for fungal skin problems. Ketoconazole 2% cream alone is appropriate for treating fungal skin infections like ringworm, athlete's foot, or tinea versicolor. Apply the cream to affected areas once or twice daily for 2-4 weeks, continuing for at least one week after symptoms resolve. Prednisone, a corticosteroid, is not recommended for fungal infections as it suppresses the immune system and can actually worsen fungal infections by reducing the body's ability to fight them. Additionally, steroids can cause a condition called tinea incognito, where the fungal infection spreads while symptoms are temporarily masked. If the fungal infection is causing significant inflammation or allergic reaction, a healthcare provider might prescribe a very short course of low-dose steroids alongside antifungal treatment, but 50 mg of prednisone is excessive for skin conditions. If your fungal infection isn't responding to topical ketoconazole, consult a healthcare provider about alternative antifungal medications rather than adding prednisone.
Some key points to consider when treating fungal skin infections with ketoconazole include:
- The use of ketoconazole has been shown to be effective in treating various types of fungal infections, including those caused by Candida and dermatophytes 2, 3.
- Topical ketoconazole formulations, such as creams and gels, are available and have been shown to be effective in treating superficial fungal infections 4, 5.
- The addition of tea tree oil to ketoconazole formulations may enhance their antifungal activity and improve their pharmaceutical characteristics 6.
- It is essential to use ketoconazole for the recommended duration and to consult a healthcare provider if the infection does not respond to treatment or if symptoms worsen.
In terms of the potential risks and benefits of using ketoconazole and prednisone together, it is essential to weigh the potential benefits of using prednisone to reduce inflammation against the potential risks of worsening the fungal infection. However, based on the available evidence, the use of prednisone 50 mg is not recommended for fungal skin infections, and alternative treatments should be considered if the infection is not responding to ketoconazole alone. It is always best to consult a healthcare provider for personalized advice on treating fungal skin infections.