A wide variety of topical antifungal drugs recently available in the market but the effects and usage of them are not completely identical. Nystatin, miconazole are particularly effective in the treatment of yeast infections (such as Candida), but no effect on filamentous fungi. Clotrimazole and ketoconazole have pretty broad spectrum on pathogenic fungi than the first 2 antifungal creams but still less effective than the new products such as terbinafine, ciclopirox olamine and butenafine..
1. For Ringworm
Ringworm is the fungal skin disease with red, itchy papular lesions, spreading out to form a round, usually appears in the inguinal skin, around the waist, buttocks, armpits, under the breasts, etc. which is caused by the trichophyton, epidermophyton, microsporum fungus.
Classical drugs used to treat ringworm is liquid alcohol BSI (benzoic acid + salicylic acid + lod), antimycose (benzoic acid + salicylic acid + boric acid) solution ASA (aspirin, sodium salicylate). Currently, there are many topical medications with Imidazole derivatives, such as miconazole, ketoconazole (nizoral), econazol, etc.
Ketoconazole cream has fast effect on the itching, common inflammation of fungal skin infections, and does not cause light sensitivity to skin.
2. For Yeast Infections
Candida infects the mouth, vagina, or skin. Candida infections are common in people with diabetes, parathyroid insufficiency and congenital diseases of the immune system, and also with HIV infection.
Cutaneous candidiasis usually responds to topical miconazole cream 2 times a day. However, chronic Candida infections around nails with nail dystrophy are really difficult to treat. Treatment should be based on fundamental reasons; hands and nails must be kept dry and applied miconazole cream daily for several months.
Ketoconazole is also a synthetic imidazole dioxolane with the effect proven on active fungistatic and fungicidal as well as sensitive fungi, and inhibits sterol biosynthesis to form esterol and alters other lipid components in fungal cell membranes as well. For Candida albicans, ketoconazole prevents the change from bud to spores causing pathogenic fungi fibers.
Ketoconazole has broad spectrum on a variety of pathogenic fungi, including eEpidermophyton floccosum, malassezia furfur, Candida spp, epidermophyton floccosum, Coccidioides immitis, paracoccidioides brasiliensis, Microsporum canis, Histoplasma capsulatum, blastomyces dermatitidis, T. rubrum and trichophyton mentagrophytes, some strains of aspergillus spp, sporothrix schenckii and cryptococcus neoformans. Ketoconazole is also effective in some Gram-positive bacteria.
3. For Jock Itch
Jock itch (tinea cruris) is a fungal skin infection that starts from the anus then spreads out to the genitals, buttocks and inner thighs, with stretch and speckled red, and pus in the middle, which are usually caused by highly humidity, especially in athletes.
So, the combination therapy of antifungal agents with moisture control is going to be effective in this case, and with antibiotics if having bacterial surinfection in the slippery ulcer. Besides the above indication, topical antifungal agents are also indicated for the treatment of seborrheic dermatitis. Although the mechanism of the disease is unknown, the use of topical antifungal drugs such as ketoconazole and ciclopirox olamine markedly reduces inflammation and scaly.
4. For Babies
There are many reasons that cause diaper rash, but the most common is due to urine, moist wet status at anal area or the long-term unchanged diapers. So, the dirty diapers have a chance to be in contact with the baby's skin for too long to form some kinds of rash, rednes. If leaving untreated, the skin became shiny and may cause pustules.
Acute diarrhea also leads to the same symptoms, usually appearing on day 2 until day 5 after the disease, with bright red anus skin, then watery, bleeding, progressive pus ulcers. Moreover, babies with thin skin will be less likely to resist with inflammatory substances and will be vulnerable to intimidating skin than older children. In babies with bottle fed, pH level in the stool is usually higher than in breastfed infants and also prone to rash skin more.
Antifungal cream is over-the-counter (OTC) medicines to treat fungal infections on babies. The common types are nystatin, miconazole, clotrimazole and ketoconazole.
Tips and Warning for Using Antifungal Creams
Currently, on the market there are many topical medications in collaboration with major components including a corticosteroid, an antibiotic and an antifungal. In general, it is recommended to minimize the use of these drugs in clinical practice, because the ingredients in the medicine can effectively interfere with each other in many cases. For example, in the case of fungal skin preparations containing steroids will worsen and reduce the effectiveness of anti-fungal drugs.
We should wash the affected area, dry that place carefully and then rub a thin layer of medication, massage and absorb all the drugs completely. Antifungal creams should be applied twice daily, usually in the morning and in the evening, with the average treatment time from 1-4 weeks to several months, depending on the disease.
Clinical symptoms are often easy up after 2 weeks of treatment, without re-infection conditions. It should be treated regularly within enough time. If there is unimproved situation after 2 weeks, the diagnosis should be reconsidered. Keep good hygiene and compliance with preventive measures to avoid yeast infections' recurrence.
Avoid eye contact with the drug. Do not combine with the corticosteroid drugs within 2 weeks of treatment for sebaceous dermatitis.
Side Effects of Using Antifungal Creams
The fungal infections often develop slowly and exist in the tissue which is difficult to absorb, that is the reason why the treatment of diseases caused by fungi is hard and time consuming, the use of antifungal drugs usually prolonged and endured as well. Therefore, fungal treatment should be very concerned about any adverse effects caused by antifungal drugs.
For example, the common undesirable effects of ketoconazole include: nausea, vomiting, constipation, flatulence, diarrhea, gastrointestinal bleeding, adrenal insufficiency, sexual in men and breast infection; also headache, dizziness, agitation or drowsiness, dermatitis, rash, urticaria, increased liver enzymes. These effects are related to dose and can be minimized.
Most cases of liver toxicity have been reported in patients taking treatment in onychomycosis and many other medications for patients with chronic persistent fungal skin. Although toxic effects to the liver caused by ketoconazole usually reversible after discontinuation of medication a few months but has been several cases of fulminant hepatic necrosis, fatty change in liver, even fatal.
As ketoconazole is highly toxic to the liver of patients using antifungal medication simultaneously with other drugs that may cause liver toxicity, and that is also the reason why it should be carefully monitored, especially for those who need long-term treatment or have a history of liver disease. It's better to use locally ketoconazole cream in this case.
Ketoconazole has an inhibition effect on hepatic enzymes, increasing plasma concentrations of the anticoagulant, anti-cancer drugs, the 2nd generation H1-antihistamines, tranquilizers and steroids. Antacids, H2 antihistamines and isoniazid reduced the effectiveness of the antifungal ketoconazole.
Ketoconazole has many dosage forms such as pills, creams, shampoos, oral suspension, and should not be used different dosage forms simultaneously containing the same active ingredient.