Topical antifungal medications for fungal nail infections

Examples

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Nonprescription topical

Brand Name	Chemical Name
Lotrimin	clotrimazole

Brand Name	Chemical Name
Micatin	miconazole nitrate

Brand Name	Chemical Name
Lamisil cream or solution	terbinafine hydrochloride 1%

Prescription topical

Brand Name	Chemical Name
Penlac	ciclopirox

Brand Name	Chemical Name
Spectazole	econazole

Brand Name	Chemical Name
Nizoral	ketoconazole

Brand Name	Chemical Name
Oxistat	oxiconazole

Ciclopirox comes as a cream or lotion (Loprox) or lacquer (Penlac). The cream or lotion is applied to the skin or nail twice a day for 2 weeks. The lacquer (nail polish) is applied once daily to the nail for up to 6 months.

Terbinafine cream or solution is applied to the skin and nail. To kill a fungal skin infection, terbinafine is applied twice daily for at least 2 weeks, or once daily for 2 to 4 weeks. To control a fungal nail infection, longer-term use is necessary.

The other medications are available as creams, lotions, solutions, or sprays and are applied directly to the nail and surrounding skin once or twice a day for 3 to 12 months.

How It Works

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Topical antifungal medications prevent the growth of or kill fungi.

Why It Is Used

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Topical antifungal medications are used to treat fungal nail infections. Which medication is used often depends on the type of infection you have.

• Terbinafine may be used to treat fungal nail infections caused by dermatophytes, such as distal subungual onychomycosis and white superficial onychomycosis.
• Ketoconazole, oxiconazole, and econazole are used to treat fungal nail infections caused by dermatophytes and yeasts, such as Candida.
• Clotrimazole is used to treat dermatophytes and molds.
• Ciclopirox is used to treat fungal infection on the nail surface (white superficial onychomycosis).

Topical medications are also used to prevent reinfection, to prevent athlete's foot from causing a fungal nail infection, and after removal of a nail.

How Well It Works

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Topical medicines may be used to treat fungal nail infections. However, they are not as successful as oral medicines in curing fungal nail infections.

• One review of research reports that ciclopirox killed fungi in about 30% of people who used it.¹
• Using a topical antifungal around the toes after an infection is cured may prevent reinfection.²

These medicines may be used when there are concerns about the risks of oral antifungal medication.

Side Effects

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Topical antifungals rarely cause side effects. Stop using the medication if it results in severe blistering, itching, redness, dryness, or irritation.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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It is not known whether these medications harm a fetus or pass into breast milk. Ciclopirox is not expected to harm a fetus. If you are pregnant, could become pregnant, or are breast-feeding, consult your health professional before using any of these medications.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Crawford F, Ferrari J (2005). Fungal nail infections, search date January 2006. Online version of Clinical Evidence (14): 1–9.

2. Habif TP (2004). Dermatophyte fungal infections section of Superficial fungal infections. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 409–439. Philadelphia: Mosby.

Credits

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Author	Sabra L. Katz-Wise
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Terrina Vail
Primary Medical Reviewer	Patrice Burgess, MD - Family Medicine
Specialist Medical Reviewer	Randall D. Burr, MD - Dermatology
Last Updated	August 23, 2006