Differentiating 7 Topical Antifungal Medicines

Similarly to how different types of viruses can cause multiple different viral infections, there are many types of fungi that can cause different types of fungal infections.

It is often a difficult task to determine which antifungal product may be the most appropriate to utilize for a specific situation. Although there are many different types of fungi that can cause infections, tinea infections are the fungal infections that are most treatable by non-prescription medicines. So, those infections are especially highlighted in this article. The purpose of this article is to aid in product selection once it is determined that a fungal infection may be present.

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This article does not discuss how to identify if an infection of unknown cause may be of fungal origin. The following are examples of credible resources that may help to decide if experienced symptoms may point toward the direction of a fungal infection.

• This resource from the Centers for Disease Control and Prevention (CDC) provides a quality introduction to fungal infections and their etiology
• This resource from MedlinePlus (US National Library of Medicine) provides further background on diagnostics and signs and symptoms to be aware of
• This resource from an academic medical center details tinea infections specifically
• Your local pharmacist and physician are essential resources

Remember, for many minor fungal infections, it is appropriate to utilize an antifungal medicine that can be purchased over-the-counter at a pharmacy or online. But, for more serious fungal infections, it is recommended to see a physician to obtain a specific recommendation.

All OTC antifungal products discussed here are products that are applied topically to the skin and/or vaginal area. Topical OTC antifungal products tend to have similar indications, and they commonly can be substituted for one another. However, the list below describes popular topical OTC antifungal medicines and it provides an introduction on how to differentiate between products.

1. Clotrimazole

Clotrimazole is one of the most common topical antifungal medicines sold at pharmacies. Clotrimazole is commonly sold as a generic product, but it is also available under the brand names of Alevazol, Lotrimin AF, Gyne-Lotrimin, etc.

Clotrimazole can be used to treat either skin-based or vaginal fungal infections. It is used to treat tinea corporis (ringworm), tinea cruris (fungal infection in the groin or buttocks area; often called “jock itch”), tinea pedis (fungal infection on the foot; often called “athlete’s foot”), or vulvovaginal candidiasis (vaginal fungal infection; often called a “yeast infection”).

Clotrimazole is available as a skin cream, ointment, external liquid solution, and vaginal cream. Clotrimazole is very similar to miconazole, discussed below. Clotrimazole and miconazole fall into the same category of antifungals.

2. Miconazole

Miconazole is another common antifungal agent, and it is available as a generic product and under many different brand names (Desenex, Micaderm, Monistat, etc).

Miconazole is an antifungal drug of choice for vaginal yeast infections. It can also be used to treat ringworm, jock itch, or athlete’s foot.

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Miconazole is available as an aerosol, aerosol powder, skin cream, vaginal cream, ointment, powder, external liquid solution, and vaginal suppository. Creams and solutions for nonprescription antifungals are typically more effective than powders and aerosols.

Miconazole is very similar to clotrimazole, discussed above. Thus, the effectiveness of miconazole is comparable to clotrimazole. Clotrimazole is utilized more commonly for skin infections and miconazole is utilized more commonly for vaginal infections, but both can be used for either purpose.

Clotrimazole and miconazole are both used twice per day for up to 4 weeks. Both of these products can be used in individuals 2 years of age or older.

FAST FACT: A frequently asked question relates to the difference between Monistat 1, Monistat 3, and Monistat 7. All three are vaginal miconazole products. Monistat 1 is a single-day, single-dose regimen with a miconazole dose of 1200 mg. Monistat 3 is a three-day, three-dose regimen that has a concentration of 200 mg per dose of miconazole. Monistat 7 is a low dose, seven-day, seven-dose regimen that contains an even lower concentration of miconazole (100 mg per dose). All regimens are noted to be equally effective, but it is recommended to ask a local pharmacist about which regimen may be most appropriate for a specific individual.

3. Tolnaftate

Tolnaftate is commonly sold as a generic product, but it is an antifungal medicine also available under brand names such as Fungi-Guard, Tinactin, Tinaspore, etc.

Whereas the other medicines prior mentioned have been noted to be used for treatment, tolnaftate can be used for both prevention and treatment of athlete’s foot. It can also be used for the treatment of ringworm and jock itch.

Tolnaftate is available as an aerosol, aerosol powder, cream, powder, and external liquid solution. Creams and solutions for nonprescription antifungals are typically more effective than powders and aerosols. Tolnaftate is used twice per day for up to 4 weeks. Tolnaftate can be used in individuals 2 years of age or older.

However, there is little evidence that prioritizes its use over clotrimazole or miconazole. Clotrimazole, for example, is noted to be a newer medicine that is slightly more effective than tolnaftate.

4. Butenafine

Butenafine is an antifungal medicine with common brand names of Lotrimin Ultra and Mentax, although it is often sold as a generic product.

Butenafine is used for skin-based fungal infections. It is used to treat ringworm, jock itch, or athlete’s foot. Butenafine is available as an external cream.

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Butenafine and terbinafine fall into slightly different antifungal medicine categories, but they are similar and largely interchangeable for most purposes. More about their relationship is described below.

5. Terbinafine

Terbinafine is an antifungal medicine with the common brand names of Lamisil Advanced and Lamisil AT.

Terbinafine is also used for skin-based fungal infections. It is used to treat ringworm, jock itch, or athlete’s foot. Terbinafine is available as a cream, gel, and external liquid solution.

Both butenafine and terbinafine may be preferable options compared to clotrimazole, miconazole, and tolnaftate for athlete’s foot specifically. Butenafine and terbinafine are often more expensive than clotrimazole or miconazole. If cost is an issue (namely for the treatment of athlete’s foot), a switch to clotrimazole or miconazole is appropriate. However, their effectiveness is comparable to clotrimazole and miconazole regarding ringworm and jock itch.

For athlete’s foot primarily on the sides and bottoms of the feet, the creme is the preferred formulation for both butenafine and terbinafine. Butenafine and terbinafine are used 1-2 times daily for up to 4 weeks. Both of these products can be used in individuals aged 12 years or older.

6. Undecylenic acid

Undeclylenic acid is an antifungal medicine commonly sold under its generic name, but it is also sold under the brand names Fungi-Nail, Myco Nail A, etc. Undecylenic acid is also used for skin-based fungal infections.

Undecylenic acid is available as a gel, external liquid solution, ointment, spray, and solution. Although it can be used for ringworm or jock itch, undecylenic acid is commonly used around the nail cuticles and/or the skin around the nails to prevent fungal growth. It may also be used to treat athlete’s foot. It is applied twice daily for 4 weeks, and the minimum age for use is 2 years.

7. Ketoconazole

Ketoconazole is available in many different dosage forms, but the OTC version of ketoconazole is a shampoo sold under the brand name Nizoral A-D.

Nizoral A-D is a medicine that is used to help control dandruff. Ketoconazole is a potent antifungal agent, but other dosage forms of ketoconazole require the advice and direction of a physician. Nizoral A-D can be applied every 3-4 days for up to 8 weeks.

Resources:

1. Fungal Diseases. Centers for Disease Control and Prevention (CDC). Last updated 19 March 2020. Accessed 28 March 2020.
2. Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and Management of Tinea Infections. Am Fam Physician. 2014 Nov 15;90(10):702-711.
3. Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001434.
4. Weinstein A, Berman B. Topical Treatment of Common Superficial Tinea Infections. Am Fam Physician. 2002 May 15;65(10):2095-2103.
5. Hart R, Bell-Syer SE, Crawford F, Torgerson DJ, Young P, Russell I. Systematic review of topical treatments for fungal infections of the skin and nails of the feet. BMJ. 1999;319(7202):79-82. doi:10.1136/bmj.319.7202.79
6. McKeny PT, Zito PM. Antifungal Antibiotics. [Updated 2020 Feb 14]. In: StatPearls [Internet].Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538168/

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