Nystatin Cream for Cutaneous Yeast Infections
For uncomplicated cutaneous candidiasis (skin yeast infections), apply nystatin cream 2-3 times daily to the affected area until complete healing, typically for 7-14 days. 1
Dosing and Administration
- Apply nystatin cream topically 2-3 times daily to candidal skin lesions and continue until healing is complete, as specified by the FDA label 1
- For very moist lesions (such as intertriginous areas), nystatin topical dusting powder is preferred over cream 1
- The same dosing regimen applies to adults, children, and neonates without modification 1
Treatment Duration
- Continue treatment for 7-14 days or until complete clinical resolution, whichever is longer 1, 2
- Most cases achieve eradication of Candida organisms within 2-6 days (mean 2.8 days), though complete wound healing may take longer 2
Special Populations
Pregnant and Lactating Women
- Nystatin is safe for use during pregnancy and lactation, as it is not systemically absorbed 3
- For vulvovaginal candidiasis in pregnancy, topical azole therapies applied for 7 days are preferred over nystatin due to superior efficacy 3
Infants and Diaper Dermatitis
- Apply nystatin cream 3-4 times daily or with each diaper change for diaper candidiasis 2
- Combine with zinc oxide barrier cream to maintain dry conditions and enhance healing 4
- Eradication of Candida typically occurs within 5 days (mean 2.8 days) 2
Important Clinical Caveats
- Nystatin cream is NOT appropriate for oral thrush, esophageal candidiasis, or vulvovaginal candidiasis—these require either nystatin suspension/pastilles or systemic azole therapy 3, 5
- For vulvovaginal candidiasis specifically, nystatin vaginal suppositories (100,000 units daily for 14 days) are required, not cream 3
- Keeping the affected area dry is as critical as antifungal therapy itself for cutaneous infections 4
- For moderate-to-severe cutaneous infections or immunocompromised patients, oral fluconazole (100-200 mg daily) may be necessary instead of topical therapy 4
When Nystatin Cream Fails
- If no improvement after 7 days of appropriate application, consider:
- Incorrect diagnosis (not Candida)
- Inadequate moisture control
- Need for systemic therapy in immunocompromised hosts 4
- Switch to topical azole (clotrimazole or miconazole) if nystatin fails, as these have equivalent efficacy for cutaneous candidiasis 4