What is the treatment for a fungal infection on the face?

Treatment for Fungal Infection on the Face

For fungal infections on the face, topical azole antifungals (clotrimazole or miconazole cream) applied twice daily for 2-4 weeks are the first-line treatment, with oral fluconazole 100-200 mg daily for 7-14 days reserved for moderate to severe or refractory cases. 1

First-Line Topical Therapy

• Apply topical azole antifungals (clotrimazole or miconazole cream) twice daily for 2-4 weeks as the primary treatment for uncomplicated facial fungal infections 1
• Nystatin cream serves as an alternative polyene option if azoles are not tolerated 1
• No single topical agent has proven superiority over others for superficial candidal infections 1
• Topical azoles are fungistatic, limiting fungal growth while relying on epidermal turnover to shed the fungus 2

When to Escalate to Oral Therapy

Oral fluconazole 100-200 mg daily for 7-14 days is indicated for:

• Moderate to severe cutaneous candidiasis 1
• Extensive or severe infections 3
• Failure of topical therapy after 2-4 weeks 4, 1

For dermatophyte infections (tinea faciei), oral options include:

• Fluconazole 50-100 mg daily or 150 mg once weekly for 2-3 weeks 5
• Itraconazole 100 mg daily for 2 weeks or 200 mg daily for 7 days 5
• Terbinafine 250 mg daily for 1-2 weeks (note: ineffective for yeast infections) 5

Critical Adjunctive Measures

• Keep the infected area dry throughout treatment, as moisture promotes fungal growth 1
• Address predisposing factors such as diabetes, immunosuppression, or excessive moisture to prevent recurrence 1
• Maintain good personal hygiene as an essential adjunct to antifungal therapy 6

Common Pitfalls to Avoid

• Do not stop treatment when skin appears healed (usually after 1 week) - complete the full 2-4 week course to prevent recurrence 2
• Avoid using terbinafine for yeast (Candida) infections on the face, as it is ineffective; azoles are preferred 2, 5
• Do not use fungistatic agents (azoles) for short courses if compliance is questionable - fungicidal agents (allylamines) are preferred for dermatophytes when treatment duration may be abbreviated 2

Treatment Algorithm by Severity

Mild, localized infection:

• Start with topical azole twice daily for 2-4 weeks 1

Moderate to severe or extensive infection:

• Initiate oral fluconazole 100-200 mg daily for 7-14 days 1
• Consider topical therapy as adjunct 7

Refractory to fluconazole (for dermatophytes):

• Switch to itraconazole or terbinafine at doses listed above 5