What cream is used to treat skin fungal infections?

Treatment of Skin Fungal Infections with Topical Creams

For dermatophyte skin infections (tinea pedis, tinea corporis, tinea cruris), terbinafine 1% cream applied once daily for 1 week is the most effective topical treatment, achieving mycological cure rates of approximately 94% and superior outcomes compared to other topical antifungals. 1

Dermatophyte Infections (Tinea)

First-Line Topical Treatment

Terbinafine 1% cream is the preferred topical agent for dermatophyte infections:

• Apply once daily for 1 week for tinea pedis, tinea corporis, and tinea cruris 1
• Achieves mycological cure rates of 93-94% 1, 2
• Superior efficacy compared to clotrimazole 1% cream used for 4 weeks (93.5% vs 73.1% cure rate) 2
• Fungicidal mechanism provides continued improvement after treatment cessation 3
• FDA-approved formulation available 4

Alternative Topical Agents for Dermatophytes

If terbinafine is unavailable or contraindicated:

• Ciclopirox olamine 0.77% cream/gel: Apply twice daily for 4 weeks, achieving ~60% mycological cure at end of treatment and 85% two weeks post-treatment 1
• Clotrimazole 1% cream: Apply twice daily for 4 weeks (less effective than terbinafine) 1
• Butenafine cream: Apply twice daily for 2 weeks (approved only for adults) 1
• Naftifine: Fungicidal allylamine with rapid onset and sustained clearance 5

Important Considerations for Dermatophyte Treatment

• Allylamines (terbinafine, naftifine) are superior to azoles against dermatophytes due to fungicidal activity 3, 5
• Shorter treatment duration with terbinafine (1 week) improves compliance compared to azoles requiring 4 weeks 2
• Keep infected areas dry and clean as adjunctive measure 1

Candidal Skin Infections

Topical Treatment for Cutaneous Candidiasis

For Candida skin infections (intertrigo, skin folds):

• Topical azoles are preferred: clotrimazole, miconazole 6, or nystatin 1
• Apply to affected area keeping the area dry 1
• Azoles are more effective than allylamines for yeast infections 5

Specific Recommendations

• Clotrimazole cream: Effective for candidal skin infections 1
• Miconazole 2%: FDA-approved topical antifungal for candidal infections 6
• Nystatin: Polyene antifungal effective against Candida species 1
• Keeping infected area dry is critical for treatment success 1

Clinical Pitfalls and Caveats

Common Mistakes to Avoid

• Do not use terbinafine as first-line for Candida infections: It has limited and unpredictable activity against yeasts 1
• Do not use azoles as first-line for dermatophytes when terbinafine is available: Terbinafine is fungicidal and more effective 3, 2
• Ensure adequate treatment duration: Even with short-course terbinafine, completing the full week is essential 2
• Address underlying risk factors: Obesity, diabetes, and moisture increase infection risk 1

When Inflammation is Present

For fungal infections with significant inflammation and pruritus:

• Consider topical antifungal-corticosteroid combinations (miconazole or terbinafine with corticosteroid) to concomitantly treat infection, reduce inflammation, and relieve itching 7
• This prevents the scratch-itch cycle that can spread infection 7

When to Consider Oral Therapy

Oral antifungals may be needed when:

• Extensive skin involvement not amenable to topical therapy 3
• Nail involvement (onychomycosis) - topical agents are usually ineffective 1
• Scalp involvement (tinea capitis) - requires systemic therapy 3
• Treatment failure with appropriate topical therapy 3