Other Topical Antifungals

OTHER TOPICAL ANTIFUNGALS

All these drugs are used for dermatophytosis.

Tolnaftate

It is an effective drug for tinea cruris and tinea corporis—most cases respond in 1–3 weeks. Because of poor penetrability, it is less effective in tinea pedis and other hyper-keratinized lesions. For the same reason, it is ineffective in tinea capitis—involving scalp and tinea unguium—involving nails.

Symptomatic relief occurs early, but if applications are discontinued before the fungus bearing tissue is shed—relapses are common. Resistance does not occur. Salicylic acid can aid tolnaftate by keratolytic action.

Tolnaftate causes little irritation, but is inferior in efficacy to imidazoles. It is not effective in candidiasis or other types of superficial mycosis.

TINADERM, TINAVATE 1% lotion, TOLNADERM 1% cream.

Ciclopirox Olamine

It is a newer drug effective in tinea infections, pityriasis versicolor and dermal candidiasis: high cure rates are reported. It penetrates superficial layers and reaches hair roots but systemic absorption is negligible. Local tolerance without irritation is good. Sensitization occurs occasionally. Formulated as nail lacquer, it has been used in onychomycosis. Also used for vaginal candidiasis.

BATRAFEN 1% cream, 1% topical solution, 1% vaginal cream, OLAMIN 1% cream.

Undecylenic Acid

It is fungistatic used topically, generally in combination with its zinc salt. It is inferior to the drugs described above; cure rates are low even after prolonged treatment. However, it is still used for tinea pedis, nappy rash and tinea cruris. Irritation and sensitization are infrequent.

TINEAFAX: Zinc undecenoate 8%, zinc naphthenate 8%, mesulphen 8%, methyl salicylate 2.5%, terpineol 2.5% oint.

Benzoic Acid

It has antifungal and antibacterial property in slightly acidic medium. It is fungistatic—weaker than tolnaftate; eradication of the fungus needs prolonged application till infected keratin is shed.

On hyperkeratotic lesions, it is used in combination with salicylic acid (as Whitfield’s ointment: benzoic acid 5%, salicylic acid 3%). The latter, by its keratolytic action, helps to remove the infected tissue and promotes the penetration of benzoic acid into the lesion. Irritation and burning sensation is experienced by many patients.

RINGCUTTER ointment.

Butenafine

It is a benzylamine congener of terbinafine with the same mechanism of action. However, it is used only topically in dermatophytosis. Efficacy in tinea cruris/corporis/pedis is similar to that of topical terbinafine.

BUTOP, FINTOP 1% cream; apply locally once or twice daily.

Quiniodochlor

By the oral route, it is used as a luminal amoebicide (Ch. No. 60). It also has weak antifungal and antibacterial activity. By external application, it has been used for dermatophytosis, mycosis barbae, seborrhoeic dermatitis, infected eczema, furunculosis and pityriasis versicolor.

It is also used in vaginal creams for monilial and trichomonas vaginitis.

VIOFORM 3% cream; DERMOQUINOL 4%, 8% cream.

Sodium Thiosulfate

It is a weak fungistatic, active against Malassezia furfur. A 20% solution applied twice daily for 3–4 weeks is effective in pityriasis versicolor. However, normal pigmentation of the skin takes longer to return. It is not useful in other superficial mycosis.

in KARPIN LOTION 20%.