Nystatin Cream with Zinc Oxide Prescription
For cutaneous candidal infections, prescribe nystatin 100,000 units/g combined with zinc oxide 20% ointment, applied to affected areas twice daily for 7-14 days until complete clinical healing is achieved. 1, 2
Prescription Format
Rx: Nystatin 100,000 units/g + Zinc Oxide 20% Ointment
- Dispense: 30-60 grams
- Sig: Apply thin layer to affected area twice daily after cleaning and drying the skin thoroughly
- Duration: Continue for 7-14 days or until complete resolution of lesions
- Refills: 0-1 1
Clinical Indications
This combination is specifically indicated for:
- Candidal diaper dermatitis with skin fold involvement 1, 3
- Cutaneous candidiasis in intertriginous areas (groin, axillae, under breasts) 1, 3
- Candidal intertrigo where moisture and maceration are present 1
The FDA approves nystatin topical preparations for cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species 3. The addition of zinc oxide provides a protective barrier that prevents maceration and does not diminish nystatin's antifungal efficacy 2.
Application Instructions for Patients
Critical steps for treatment success:
- Keep the area dry between applications—this is essential for treatment efficacy 1
- Clean and thoroughly dry the affected area before each application 1
- Apply a thin layer to cover the entire affected area and slightly beyond the visible margins 1
- For diaper area: Change diapers frequently and allow air exposure when possible 1
- For skin folds: Use absorbent material or powder (after cream absorption) to maintain dryness 1
Treatment Duration and Monitoring
- Standard duration: 7-14 days until complete clinical healing 1
- Reassessment required if no improvement after 7 days—this may indicate treatment failure or misdiagnosis 1
- Do not discontinue prematurely after symptomatic improvement; continue until complete healing to prevent recurrence 1
Common Pitfalls to Avoid
Failure to maintain dryness is the most common cause of treatment failure, even with appropriate antifungal therapy 1. The zinc oxide component helps protect against moisture-induced maceration, particularly under occlusive conditions like diapers 2.
Premature discontinuation after symptomatic improvement but before complete healing leads to recurrence 1.
Alternative Considerations
If nystatin with zinc oxide is unavailable, acceptable alternatives include:
- Topical azoles (clotrimazole 1% or miconazole 2%) with zinc oxide barrier cream applied separately 1
- Nystatin powder (100,000 units/g) for areas requiring maximum dryness 4
However, in a comparative study, clotrimazole showed superior efficacy to nystatin alone for diaper dermatitis 5, though the combination with zinc oxide may enhance nystatin's performance by maintaining optimal skin conditions 2.
When to Consider Alternative Therapy
- No improvement after 14 days: Switch to azole antifungal or consider oral fluconazole 4
- Suspected C. glabrata: May require longer treatment duration or alternative agents 4
- Recurrent infections: Investigate underlying predisposing conditions (diabetes, immunodeficiency) 1
Safety Profile
Nystatin is not absorbed from intact skin or mucous membranes, making it extremely safe for topical use 3. The combination with zinc oxide has been studied in infants and shown to be safe and well-tolerated 2, 5. This formulation is appropriate for all age groups, including neonates and pregnant women 6.