What is an appropriate antifungal (anti-fungal) cream for a whole-body fungal infection?

From the Guidelines

For a whole-body fungal infection, I recommend using an over-the-counter cream containing either clotrimazole 1%, miconazole 2%, or terbinafine 1% as the first line of treatment. Apply a thin layer to affected areas twice daily for 2-4 weeks, even if symptoms improve sooner. For extensive fungal infections covering large body areas, prescription-strength options like ketoconazole 2% cream may be more appropriate, which would require a doctor's evaluation 1. When applying, ensure skin is clean and dry, use enough to cover the affected area but avoid excessive application, and wash hands before and after use. These medications work by disrupting the fungal cell membrane or inhibiting essential enzymes needed for fungal growth. If the infection doesn't improve after two weeks of treatment, shows signs of bacterial infection (increased redness, warmth, pus), or if you have diabetes or a weakened immune system, consult a healthcare provider as you may need oral antifungal medication instead, such as fluconazole, which is recommended for candidemia treatment 1. It's essential to note that the treatment approach may vary depending on the specific type of fungal infection and the patient's overall health condition, and oral fluconazole, 200–400 mg (3–6 mg/kg) daily, for 14–21 days is recommended for systemic antifungal therapy 1.

Some key points to consider when treating whole-body fungal infections include:

• The importance of proper hygiene and skin care to prevent the spread of infection
• The need for prompt medical evaluation if symptoms worsen or do not improve with treatment
• The potential for drug interactions and side effects with oral antifungal medications, such as fluconazole 1
• The recommendation for intravenous catheter removal in nonneutropenic patients with candidemia 1

From the FDA Drug Label

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.

• Ketoconazole cream is an appropriate antifungal cream for treating various fungal infections, including those that can affect the whole body, such as tinea corporis and tinea versicolor 2.
• However, it is essential to note that the treatment of a whole-body fungal infection may require a comprehensive approach, and topical treatment alone may not be sufficient.
• The use of ketoconazole cream should be done under the guidance of a healthcare professional, as they can assess the severity of the infection and recommend the most appropriate treatment plan.

From the Research

Antifungal Creams for Whole-Body Fungal Infections

• There are several antifungal creams that can be used to treat whole-body fungal infections, including:
  • Clotrimazole, a broad-spectrum antimycotic drug mainly used for the treatment of Candida albicans and other fungal infections 3
  • Croconazole, a new broad spectrum agent in the treatment of fungal skin infections, which has a broad spectrum of activity against dermatophytes, moulds, yeasts, dimorphic fungi and some skin-relevant bacteria 4
  • Ciclopirox olamine, an active pharmaceutical ingredient used in antifungal formulations, which has been shown to be effective against the dermatophyte Trichophyton rubrum 5
  • Terbinafine hydrochloride, an active pharmaceutical ingredient used in antifungal formulations, which has been shown to be effective against the dermatophyte Trichophyton rubrum 5

Effectiveness of Antifungal Creams

• The effectiveness of antifungal creams can vary depending on the type of fungal infection and the active ingredient used. For example:
  • Clotrimazole has been shown to be effective in treating tinea pedis, vulvovaginal and oropharyngeal candidiasis 3
  • Croconazole has been shown to be effective in treating pityriasis versicolor, candidiasis and trichophytosis 4
  • Ciclopirox olamine and terbinafine hydrochloride have been shown to be effective against the dermatophyte Trichophyton rubrum 5

Considerations for Treatment

• When choosing an antifungal cream, it is essential to consider the type of fungal infection, the severity of the infection, and the potential side effects of the treatment. For example:
  • Itraconazole has been shown to be the most effective oral antifungal drug in treating chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine and then griseofulvin 6
  • The treatment of deep-seated mycotic infections may require the use of broad-spectrum antifungal agents such as amphotericin B, flucytosine, miconazole and ketoconazole 7