From the Guidelines
For fungal skin infections on the face in adults, the first-line treatment is typically an antifungal cream containing clotrimazole 1%, miconazole 2%, or terbinafine 1%. Apply a thin layer to the affected area twice daily (morning and evening) after gently cleansing the skin with mild soap and water. Continue treatment for 1-2 weeks after symptoms resolve, usually for a total of 2-4 weeks. These topical azoles and allylamines work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell survival 1. Keep the affected area clean and dry, as fungi thrive in warm, moist environments. Avoid sharing towels or personal items to prevent spread. If the infection doesn't improve within two weeks, shows signs of bacterial superinfection (increased redness, warmth, pain), or if you have a compromised immune system, consult a healthcare provider as oral antifungals may be necessary. For facial application, be careful to avoid contact with eyes and mucous membranes.
Some key points to consider when treating fungal skin infections on the face include:
- Keeping the affected area clean and dry to favor healing and prevent spread
- Avoiding sharing personal items to prevent transmission
- Monitoring for signs of bacterial superinfection or worsening of symptoms
- Considering oral antifungals if the infection is severe or does not respond to topical treatment
It's worth noting that the provided evidence, such as the study from 1, discusses the treatment of onychomycosis and nondermatophyte moulds, which is not directly relevant to the treatment of fungal skin infections on the face. However, the studies from 1 and 1 provide relevant guidance on the treatment of candidal skin infections, which can be applied to the treatment of fungal skin infections on the face.
From the Research
Topical Treatments for Fungal Skin Infections
The first line topical treatment for fungal skin infections (dermatophytosis) on the face in adults includes:
- Azole drugs such as miconazole, clotrimazole, and ketoconazole, which are fungistatic, limiting fungal growth but depending on epidermal turnover to shed the still-living fungus from the skin surface 2
- Allylamines and benzylamines such as terbinafine, naftifine, and butenafine, which are fungicidal, actually killing the fungal organisms 2
- Fenticonazole, an imidazole derivative with a broad spectrum of antimycotic activity against dermatophytes and yeasts 3
Treatment Preferences
Fungicidal drugs are often preferred over fungistatic drugs for treatment of dermatophytic fungal infections, since treatment times as short as one application daily for 1 week are associated with high cure rates 2 Terbinafine is considered a first-line treatment option, along with itraconazole, in cutaneous mycoses which warrant systemic treatment; topical terbinafine is a treatment of choice in less extensive mycoses 4
Specific Treatment Options
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 4 Fenticonazole 2% cream, spray or powder is associated with a mycological response in 100% of patients with pityriasis versicolor, 96.3% of those with tinea infections and 95.2% of patients with Candida infections 3