TOPICAL ANTIFUNGALS

Presented by : DR. Rasha Bennour

Supervised by: Nabil El-Gehawi.MD

What are topical antifungals ?
Topical antifungal agents are applied locally to the
skin, on the nail, onto mucus membranes or
vaginally , to treat fungal infections.
They kill or inactivate fungi and yeast.
Topical antifungal agents are available as creams,
ointments, solutions, lotions, powders, gels,
sprays , lacquers ,shampoos, and other forms,
which can be applied locally on the area that needs
to be treated. They can often cure localized
infections, although recurrence is common.
Indications:

 Dermatophyte infections such as tinea corporis,

tinea cruris , tinea faciei, tinea manuum ,tinea
pedis.
 As an addition to oral therapy for tinea capitis
and tinea barbae.
 Yeast infections such as candida intertrigo,
pityriasis versicolor.
 Mould skin infections such as tinea nigra and
nail plate infections
I) agents broad-spectrum activity
against( dermatophytes, candida, pv):
1.Ciclopirox olamine cream (batrafen):
It acts by inhibition of the synthesis of cell membrane
proteins.It has also antibacterial and anti-inflammatory
activities.
e.g. (mycoster 1%).
Ciclopirox 8% nail lacquer, capable of penetrating the
nail, applied once daily ,is effective in the treatment of
onychomycosis,it chelates polyvalent cations resulting
in the inhibition of metal dependent enzymes that
degrade peroxides in the fungal cell wall.
2.Haloprogin 1% (halotex):cream and
solution. Irritation is a possible side effect.
3.Iodo-chlorhydroxyquin( vioform) :
It has an antibacterial and a mild antifungal
properties, It may cause neurotoxicity,It should be
applied to diaper dermatitis areas in infants for
short periods only.
4.Propylene glycol :
It is a keratolytic with broad-spectrum antimycotic
activities. Propylene glycol-urea-lactic acid solution
may be of benefit in onychomycosis.
5. Imidazoles :
e.g. Miconazole (Daktarin), isoconazole nitrate
(Travogen), tioconazole (Trosyd), clotrimazole
(canesten) , ketoconazole 2% (Nizoral cream or
shampoo) and sertaconazole (Dermofix).
Most of them are active also against erythrasma
and some gram-positive bacteria.
Note: Miconazole (Daktarin oral gel) should not be
used in patients who are taking warfarin because it
has been reported to cause a dangerous interaction,
which could result in serious bleeding.
6.Allylamines:
cure rates and more rapid responses than older topical
antifungals.
e.g. Terbinafine 1% (Lamisil cream) and Naftifine
1% (Exoderil cream).

7. Amorolfine 0.25% :
It has a broad spectrum activity and like imidazoles,
it inhibits ergosterol synthesis.
Amorolfine 5% nail lacquer applied once or twice
weekly in onychomycosis without matrix
involvement may be effective.
II)agents mainly active against
dermatophyte infections:
1.Whitfield's ointment:
Salicylic acid 3% ( keratolytic).
Benzoic acid 6 %( fungistatic).
Side effects: irritation, systemic absorption may lead to salicylism.
2.Undecylenic acid: and it's salt powder, cream or solution.
(it’s a fatty acid that works by preventing fungus from growing on the
skin.)
3.Tolnaftate 1% ointment: (Tineacure , Tinaderm).
It has a fungicidal action by inhibition of squalene epoxidase (as
allylamines).

Side Effect: irritation of the treated skin may occur.

4.Castellani's paint:
Magenta red (Basic fuchsin) .
Boric acid.
Phenol.
Resorcinal.
Alcohol, acetone, aqua.
Eliminating the fuchsin makes it colorless without loss of
activity.
It has also an anti-bacterial action and it is especially used in
intertriginous infections ,e.g. interdigital tinea pedis.

Side effects:
staining, irritation, and toxic reactions to phenol (avoided in
infants).
III) agents mainly active against candidal
infections:
1.Gentian violet 1% :
Is a triphenylmethane dye in aqueous or alcoholic solution, It has also
antibacterial action, being cheap, chemically stable and easy prepare.
Staining and skin irritation are the main S/E.
2.Nystatin (natamycin):
A polyene macrolide antibiotic derived from STREPTOMYCES NOURSEI (a
species of the actinomycete),it is too toxic for parentral administration
,topically nontoxic and available for oral,vaginal,and topical application .it is
the treatment of choice for oral candidiasis (clotrimazole is equally
effective) (e.g. Nilstat ; Mycostatin)
3.Potassium permanganate 1/8000 solution:
It has a nonspecific antifungal activity mainly against candidiasis of
intertriginous areas (napkin dermatitis).
IV) agents mainly active against
pityriasis versicolor organism:
1.Selenium sulfide 2.5%( selsun shampoo) :
It increases fungal shedding by decreasing corneocyte production
through its cytostatic effect on cells.reported S/E include skin
irritation, increased hair loss and discoloration.
Also used in seborrheic drmatitis.
2. zinc pyrithione(head &shoulder shampoo) :
They used in treating and preventing itching, peeling, and scaling
(oily or crusting)of the scalp caused by dandruff or seborrhea skin.
3. sodium thiosulphate 25%:
Sodium thiosulfate lotion is a topical antifungal and keratolytic
agent. It works by killing the fungus that causes tinea versicolor. The
keratolytic helps the antifungal reach the deep layers of the skin.
NOTE:
Tinea capitis and onychomycosis require the use of
systemic antifungals. Other forms of superfacial
fungal infection , however, can usually be treated
topically with any of the topical agents in a 3 week
course of twice daily application.
Topical antifungals during pregnancy:
-The use of antifungals in the topical treatment of
infections of hair, skin and nails is common. To
date, no topical antifungal treatments have been
shown to be teratogenic during human pregnancy.
Topical azoles are not or are minimally absorbed
and hence are allowed at any stage of pregnancy.

-Also topical antifungals are compatible during

breast feeding.
Thank for your attention