Topical antifungal medications for fungal nail infections

Examples

Nonprescription topical

Generic Name	Brand Name
clotrimazole	Lotrimin
miconazole nitrate	Micatin
terbinafine hydrochloride 1%	Lamisil cream or solution

Prescription topical

Generic Name	Brand Name
ciclopirox	Loprox, Penlac
econazole	Spectazole
ketoconazole	Nizoral
oxiconazole	Oxistat

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

Topical antifungal medications prevent the growth of or kill fungi.

Why It Is Used

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

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

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

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.

Author:	Sabra L. Katz-Wise	Last Updated: August 23, 2006
Medical Review:	Patrice Burgess, MD - Family Medicine Randall D. Burr, MD - Dermatology
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