Table of ContentsView AllTable of ContentsHow They WorkTypesOver-the-Counter OptionsPrescriptionsHow to Choose
Table of ContentsView All
View All
Table of Contents
How They Work
Types
Over-the-Counter Options
Prescriptions
How to Choose
High potency doesn’t necessarily mean that an antifungal is better at clearing afungal skin infection. In the end, the best topical antifungal is the one that treats the infection with the lowest dose, duration of treatment, and side effects.
How Antifungal Cream Works
There are seven major classes of topical antifungals used in the U.S., each of which has slightly differentmechanisms of action:
Types of Topical Antifungals
With consistent use, topical antifungals can kill the fungus at the site of the infection. This differs fromoral antifungalsthat deliver the medication systemically (throughout the whole body).
There are no less than 30 topical antifungals approved for use in the U.S., used either on their own or in combination with an oral antifungal.
Over-the-Counter Antifungals and Their Uses
OTC topical antifungalsare effective in treating most uncomplicated fungal skin infections, including those affecting the genitals and anus.
These include common fungal infections like:
There are six OTC options used to treat these and other conditions:
When Prescription Topical Antifungals Are Needed
Prescription topical antifungals are typically prescribed when an infection does not clear with an OTC product. They may also be used in combination with an oral antifungal to treat a severe local infection or a systemic infection (such as can occur in people who areimmunocompromised).
They are often used to treat severeoral yeast infections (thrush)orfungal nail infections(which are typically hard to treat).
In severe cases, a topical antifungal may be combined with acorticosteroid druglike triamcinolone to help ease inflammation, itching, and pain that can accompany the infection.
ConditionPrescription drug optionsOral thrushNystatin oral solution or lozengesMiconazole oral gelAmphotericin B creamYeast infectionsClotrimazole vaginal suppositoryClotrimazole 10% vaginal creamEconazole cream Tioconazole creamAmphotericin BScalp ringwormCiclopirox liquid or shampooFungal nail infectionAmorolfine nail lacquerEconazole solutionCiclopirox nail lacquerBifonazole creamEfinaconazole nail solutionTavaborole nail solutionHow to Choose the Best Topical AntifungalThe general aim of any antifungal therapy is to use the lowest possible dose for the shortest period to clear the infection. The stronger the dose or longer the treatment, the more likely you are to experience side effects.To illustrate the concern, here is how the side effects of one of the most common OTC antifungals, Lotrimin AF (clotrimazole), compares to Mytrex (nystatin + triamcinolone), one of the stronger prescription formulations:Lotrimin AF (Clotrimazole)RednessItchingSwellingBurning or stingingTendernessTiny, pimple-like bumpsSkin dryness and flakingMytrex (Nystatin + Triamcinolone)RednessItchingSwellingBurning or stingingTenderness or painSevere blisteringRash or hivesSkin peelingChanges in skin colorSkin thinningEasy bruisingStretch marksAnaphylaxis(a severe whole-body allergy)This is why treatment is generally staged, using an OTC topical antifungal before moving on to a prescription topical and/or oral antifungal.SummaryAntifungal creams are used to treat a variety of fungal skin infections. There are many different types of topical antifungals, both over-the-counter and prescription, that vary in their strength, mechanism of action, duration of treatment, and recommended uses.The best antifungal cream is the one that can clear the infection quickly at the lowest possible dose. Speak with your healthcare provider to choose the option best suited for your type of infection.
How to Choose the Best Topical Antifungal
The general aim of any antifungal therapy is to use the lowest possible dose for the shortest period to clear the infection. The stronger the dose or longer the treatment, the more likely you are to experience side effects.
To illustrate the concern, here is how the side effects of one of the most common OTC antifungals, Lotrimin AF (clotrimazole), compares to Mytrex (nystatin + triamcinolone), one of the stronger prescription formulations:
Lotrimin AF (Clotrimazole)RednessItchingSwellingBurning or stingingTendernessTiny, pimple-like bumpsSkin dryness and flakingMytrex (Nystatin + Triamcinolone)RednessItchingSwellingBurning or stingingTenderness or painSevere blisteringRash or hivesSkin peelingChanges in skin colorSkin thinningEasy bruisingStretch marksAnaphylaxis(a severe whole-body allergy)
Lotrimin AF (Clotrimazole)RednessItchingSwellingBurning or stingingTendernessTiny, pimple-like bumpsSkin dryness and flaking
Redness
Itching
Swelling
Burning or stinging
Tenderness
Tiny, pimple-like bumps
Skin dryness and flaking
Mytrex (Nystatin + Triamcinolone)RednessItchingSwellingBurning or stingingTenderness or painSevere blisteringRash or hivesSkin peelingChanges in skin colorSkin thinningEasy bruisingStretch marksAnaphylaxis(a severe whole-body allergy)
Tenderness or pain
Severe blistering
Rash or hives
Skin peeling
Changes in skin color
Skin thinning
Easy bruising
Stretch marks
Anaphylaxis(a severe whole-body allergy)
This is why treatment is generally staged, using an OTC topical antifungal before moving on to a prescription topical and/or oral antifungal.
Summary
Antifungal creams are used to treat a variety of fungal skin infections. There are many different types of topical antifungals, both over-the-counter and prescription, that vary in their strength, mechanism of action, duration of treatment, and recommended uses.
The best antifungal cream is the one that can clear the infection quickly at the lowest possible dose. Speak with your healthcare provider to choose the option best suited for your type of infection.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Poojary SA.Topical antifungals: a review and their role in current management of dermatophytoses.Clin Dermatol Rev.2017;1(Suppl 1):S24-S29. doi:10.4103/CDR.CDR_34_17Jana S, Gayen S, Kumari R, et al.Mechanism of action of antifungal agents.How Synthetic Drugs Work. 2023;1(1):431-445. doi:10.1016/B978-0-323-99855-0.00019-1Centers for Disease Control and Prevention.Antimicrobial-resistant fungal diseases.Centers for Disease Control and Prevention.About fungal diseases.National Health Service (UK).Guidelines for the prescribing of topical antifungal agents.Centers for Disease Control and Prevention.Candidiasis.Centers for Disease Control and Prevention.Treatment of ringworm and fungal nail infections.Mijaljica D, Spada F, Harrison IP.Emerging trends in the use of topical antifungal-corticosteroid combinations.J Fungi (Basel). 2022 Aug;8(8):812. doi:10.3390/jof8080812MedlinePlus.Nyastatin and triamcinolone.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Poojary SA.Topical antifungals: a review and their role in current management of dermatophytoses.Clin Dermatol Rev.2017;1(Suppl 1):S24-S29. doi:10.4103/CDR.CDR_34_17Jana S, Gayen S, Kumari R, et al.Mechanism of action of antifungal agents.How Synthetic Drugs Work. 2023;1(1):431-445. doi:10.1016/B978-0-323-99855-0.00019-1Centers for Disease Control and Prevention.Antimicrobial-resistant fungal diseases.Centers for Disease Control and Prevention.About fungal diseases.National Health Service (UK).Guidelines for the prescribing of topical antifungal agents.Centers for Disease Control and Prevention.Candidiasis.Centers for Disease Control and Prevention.Treatment of ringworm and fungal nail infections.Mijaljica D, Spada F, Harrison IP.Emerging trends in the use of topical antifungal-corticosteroid combinations.J Fungi (Basel). 2022 Aug;8(8):812. doi:10.3390/jof8080812MedlinePlus.Nyastatin and triamcinolone.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Poojary SA.Topical antifungals: a review and their role in current management of dermatophytoses.Clin Dermatol Rev.2017;1(Suppl 1):S24-S29. doi:10.4103/CDR.CDR_34_17Jana S, Gayen S, Kumari R, et al.Mechanism of action of antifungal agents.How Synthetic Drugs Work. 2023;1(1):431-445. doi:10.1016/B978-0-323-99855-0.00019-1Centers for Disease Control and Prevention.Antimicrobial-resistant fungal diseases.Centers for Disease Control and Prevention.About fungal diseases.National Health Service (UK).Guidelines for the prescribing of topical antifungal agents.Centers for Disease Control and Prevention.Candidiasis.Centers for Disease Control and Prevention.Treatment of ringworm and fungal nail infections.Mijaljica D, Spada F, Harrison IP.Emerging trends in the use of topical antifungal-corticosteroid combinations.J Fungi (Basel). 2022 Aug;8(8):812. doi:10.3390/jof8080812MedlinePlus.Nyastatin and triamcinolone.
Poojary SA.Topical antifungals: a review and their role in current management of dermatophytoses.Clin Dermatol Rev.2017;1(Suppl 1):S24-S29. doi:10.4103/CDR.CDR_34_17
Jana S, Gayen S, Kumari R, et al.Mechanism of action of antifungal agents.How Synthetic Drugs Work. 2023;1(1):431-445. doi:10.1016/B978-0-323-99855-0.00019-1
Centers for Disease Control and Prevention.Antimicrobial-resistant fungal diseases.
Centers for Disease Control and Prevention.About fungal diseases.
National Health Service (UK).Guidelines for the prescribing of topical antifungal agents.
Centers for Disease Control and Prevention.Candidiasis.
Centers for Disease Control and Prevention.Treatment of ringworm and fungal nail infections.
Mijaljica D, Spada F, Harrison IP.Emerging trends in the use of topical antifungal-corticosteroid combinations.J Fungi (Basel). 2022 Aug;8(8):812. doi:10.3390/jof8080812
MedlinePlus.Nyastatin and triamcinolone.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
