Antifungal Creams: Which cream should I use?

Fungal infections are common and often uncomfortable. Fortunately, there are several effective antifungal creams available over the counter to help you manage and treat them. Here's a breakdown of some of the most widely used options and what you need to know about each.

1. Clotrimazole (Canesten)

What It Treats

Clotrimazole is a versatile antifungal. It’s used to treat athlete’s foot, ringworm, sweat rash, nappy rash, vaginal thrush, and even fungal nail infections.

How It Works

Clotrimazole works by blocking the growth of fungi, stopping them from spreading and helping your body fight off the infection.

Why It’s Useful

This cream has different strengths, with clotrimazole and hydrocortisone available for added relief from inflammation, itching, and redness. The 1% version is widely used for common skin infections, while the 2% version is specifically for treating vaginal thrush.

How to Use

Apply directly to the affected area 2-3 times a day. Continue using the cream until the symptoms have cleared up, even if the rash seems to improve. It’s safe for use during pregnancy and breastfeeding.

Pharmacist Recommended

• Canesten Cream (Clotrimazole 1%) (20g)
• Daktarin Aktiv Cream (15g)

2. Econazole & Ketoconazole

Econazole

Used to treat ringworm, tinea versicolor (sun fungus), and vaginal thrush. It’s a strong antifungal and should be used cautiously during pregnancy, particularly in the second and third trimesters.

Ketoconazole

This is another widely-used antifungal. It’s effective for athlete’s foot, sweat rash, dandruff, and pityriasis versicolor. Available in both cream and shampoo form, ketoconazole is often preferred in shampoo form for treating dandruff or as a wash for pityriasis versicolor.

Why It’s Useful

Both econazole and ketoconazole are powerful antifungals that work well for various skin infections. They target fungi on the skin’s surface and help to clear up even more stubborn infections that other treatments might not manage.

3. Amorolfine

What It Treats

Amorolfine is most commonly used for treating fungal nail infections, particularly in the early stages.

How It Works

Available as both a cream and a nail lacquer, amorolfine directly targets fungal cells, preventing their growth and helping the infection clear up. The nail lacquer is especially useful for treating early-stage fungal nail infections, as it can penetrate the nail and fight the fungus.

Why It’s Useful

Though antifungal tablets (like terbinafine) may be required for more advanced fungal nail infections, amorolfine lacquer can be a helpful first step. It offers a convenient, topical solution for treating mild to moderate nail infections before turning to more aggressive treatments.

4. Terbinafine

What It Treats

Terbinafine is another potent antifungal cream often used to treat skin infections like athlete's foot, ringworm, and jock itch. It can also be used for fungal nail infections, though in these cases, oral tablets may be recommended for more effective results.

How It Works

Terbinafine works by interfering with the fungus's cell membrane, effectively stopping its growth. By disrupting this critical process, it prevents the fungus from spreading and helps to clear the infection faster.

Why It’s Useful

Due to its strong antifungal properties, terbinafine is often recommended for treating more persistent skin infections. It’s available in both cream and tablet forms. The cream is ideal for localized skin infections, while tablets are used for fungal nails or more widespread infections.

How to Use

Apply the cream directly to the affected area once or twice a day, as directed. Oral terbinafine tablets may be necessary for nail infections. Treatment should continue for the full course, even if symptoms improve before the treatment is finished.

Pharmacist Recommended

• Lamisil Antifungal Cream (Terbinafine 1%) (15g)

Choosing the right antifungal cream depends largely on the type of fungal infection you're dealing with, as each cream works differently based on its active ingredients. Here's a more detailed guide to help you find the most suitable option for common fungal conditions:

Athlete’s Foot

Athlete's foot (tinea pedis) is a fungal infection that typically affects the skin between the toes, causing itching, burning, and cracking. Terbinafine and clotrimazole are both excellent choices for treating athlete's foot. Both terbinafine and clotrimazole target the root cause of athlete's foot, ensuring the fungus is effectively eliminated and the infection doesn’t spread.

Terbinafine (e.g., Lamisil)

Terbinafine is one of the most effective treatments for athlete's foot. It works quickly to kill the fungus, often providing relief in just a few days. This antifungal disrupts the fungus's cell membrane, preventing further growth. It's typically applied once or twice daily for 1–2 weeks.

Clotrimazole (e.g., Canesten)

Clotrimazole works by inhibiting the growth of fungi. It’s a good option for milder cases or if you’re looking for a non-prescription solution. Apply it to the affected area once or twice a day until the infection clears up.

Ringworm

Ringworm (tinea corporis) is a common fungal infection that can appear anywhere on the body. It typically presents as a red, circular rash with a clear centre. Econazole, ketoconazole, and clotrimazole are well-suited for treating ringworm. These antifungal creams disrupt the growth and reproduction of the fungi, eliminating them and preventing the infection from spreading further.

Econazole

This antifungal cream is effective against ringworm as well as other skin fungal infections. It targets the fungal cell membrane, stopping the infection from spreading. Econazole can be used twice a day, typically for 2–4 weeks.

Ketoconazole (e.g., Nizoral)

Ketoconazole is effective against a wide range of fungal infections, including ringworm. Its antifungal activity helps stop the fungi from growing and spreading. For full effect, apply the cream once or twice daily for a few weeks.

Clotrimazole

Clotrimazole is an affordable and widely available option for mild to moderate cases of ringworm. It’s effective in treating many types of fungal infections, including ringworm, and is often used twice daily.

Fungal Nail Infections

Fungal nail infections (onychomycosis) can affect both fingernails and toenails, causing discolouration, thickening, and brittleness. A cream like amorolfine Curanail nail lacquer or oral treatments like terbinafine tablets are often the most effective options for fungal nails. Amorolfine lacquer targets the infection directly on the nail, whereas terbinafine tablets address the infection internally, ensuring a more comprehensive approach when the infection has spread or is persistent.

Amorolfine Nail Lacquer

Amorolfine is an antifungal nail lacquer used specifically for fungal nail infections. It’s applied directly to the affected nails, and the lacquer forms a protective barrier over the infected nail, allowing it to penetrate the nail and combat the infection. For best results, use it once a week until the infection is cleared.

Terbinafine Tablets

For more severe nail infections, oral terbinafine tablets may be necessary. These tablets work from the inside out, effectively targeting the infection at its root. Depending on the severity of the infection, your doctor may recommend a course of tablets for 6–12 weeks.

Vaginal Thrush

Vaginal thrush (candidiasis) is a yeast infection caused by an overgrowth of Candida fungus, often leading to itching, irritation, and discharge. Clotrimazole, econazole, and ketoconazole are commonly used to treat vaginal thrush. These antifungal creams or pessaries target the fungal infection directly in the affected area, reducing symptoms quickly.

Clotrimazole (e.g., Canesten)

Available as both a cream and pessary, clotrimazole is one of the most common treatments for vaginal thrush. The pessary is inserted into the vagina, while the cream is applied externally to soothe irritation.

Econazole

Econazole is also effective against vaginal thrush, often prescribed as a pessary for internal use. It works by reducing fungal growth in the vagina.

Ketoconazole

Ketoconazole can be used in the treatment of vaginal thrush, but it’s typically used when other options have failed.

Jock Itch

Jock itch (tinea cruris) is a fungal infection that affects the groin area, causing redness, itching, and a rash. Terbinafine and clotrimazole are effective options for treating jock itch. Both terbinafine and clotrimazole target the fungi, causing the infection and reducing inflammation and itching.

Terbinafine

Like for athlete’s foot, terbinafine works well for jock itch by stopping the fungi from multiplying and spreading. Apply it once or twice daily to the affected area for 1–2 weeks.

Clotrimazole

This is a good alternative for milder cases, effectively relieving itching and redness. Apply it 1–2 times daily for several weeks.

While antifungal creams are great for treating many common fungal infections, there are times when you should seek medical advice rather than trying to treat it yourself.

If your skin infection isn’t improving after using an antifungal cream for a week or two, seeing your doctor’s a good idea. Some fungal infections can be tougher to treat or might need stronger medication. If you’ve been using the cream as directed and still see no improvement, don’t wait too long to get help.

Another reason to see a doctor is if the infection is spreading. If you notice that the rash, redness, or itching is getting worse or affecting a larger area, it’s time to seek medical advice. Sometimes, fungal infections can be resistant to over-the-counter treatments or could be something else entirely, like a bacterial infection or allergic reaction.

Pregnancy and breastfeeding require extra caution. While many antifungal creams are safe during these times, always check with your doctor before using any treatment. Your doctor can recommend the safest option for you and your baby.

If you’re dealing with a fungal nail infection that’s not improving with a topical cream, it’s time to see a doctor. Nail infections can be persistent, and oral treatments might be necessary for effective treatment. In these cases, antifungal tablets like terbinafine are often more effective. It can take up to 6 months for a nail fungal infection to be fully treated as the whole nail has to grow over. With this in mind, it may not always be necessary to see your doctor. However, if you have a nail infection on more than one nail then you will have to go to your doctor regardless.

Lastly, if you have a weakened immune system or underlying health issues like diabetes, you should consult a doctor. These conditions can make it harder for your body to fight off infections, and you may need a stronger or more tailored treatment plan.

When in doubt, it's always best to contact your local healthcare professional. They can help determine the right treatment and avoid any potential complications.

Frequently Asked Questions About Antifungal Creams

Here are some of the most common questions people have about antifungal creams, and their answers:

1. How do antifungal creams work?

Antifungal creams work by targeting and killing the fungi causing the infection. They often disrupt the cell membranes of fungi, preventing them from growing and spreading. Depending on the active ingredient, these creams can either stop the fungi from producing essential compounds or weaken their cell walls, leading to their destruction. Most antifungal creams need to be applied consistently over a period of time to ensure the infection is fully cleared.

2. How long does it take for antifungal creams to work?

The time it takes for antifungal creams to work depends on the severity and type of infection. For most skin infections like athlete's foot or ringworm, you should start seeing improvement within 2–3 days of application. However, it’s important to continue using the cream for the full course (typically 1–2 weeks) to ensure the infection is completely eradicated. For nail infections, it may take several weeks for noticeable improvement, and in more severe cases, oral antifungal treatment may be necessary.

3. Can antifungal creams be used during pregnancy or while breastfeeding?

Many antifungal creams are considered safe for use during pregnancy and breastfeeding. However, it’s essential to consult with your local healthcare provider before using any antifungal product during pregnancy, especially in the first trimester. They can help determine which treatment is best for you based on the type of infection and its severity. Topical treatments are often preferred over oral medications during pregnancy due to their limited absorption into the bloodstream.

4. Can I use antifungal cream on my face?

While many antifungal creams can be used on the skin, some may be too harsh for sensitive areas like the face. It’s best to choose a product specifically designed for facial use, and consult with a healthcare provider if you're unsure. For conditions like ringworm or yeast infections that can appear on the face, antifungal creams can be applied, but be cautious around the eyes and mouth. If irritation occurs, discontinue use and seek professional advice.

5. What should I do if the cream doesn’t seem to be working?

If you’ve been using an antifungal cream as directed and aren’t seeing improvement after a week or two, there could be a few reasons why it’s not working. The infection may be more severe than initially thought, or you might be using the wrong treatment for the type of fungus. In such cases, it’s best to consult with a healthcare provider. They may recommend a stronger antifungal treatment, an oral antifungal medication, or further tests to identify the specific type of fungus.

6. Can I use antifungal creams for fungal nail infections?

Antifungal creams can effectively treat fungal nail infections in their early stages, but they are often less effective than oral treatments. Nail lacquer treatments, such as amorolfine, can be helpful for mild fungal nail infections. However, more advanced cases may require oral antifungal tablets, such as terbinafine, for better results. Always follow the guidance of a healthcare provider for the best course of treatment.

7. How often should I apply antifungal cream?

The application frequency depends on the antifungal cream you are using. Most creams are applied once or twice daily. It’s crucial to follow the instructions on the packaging or as your healthcare provider advises. Consistent application is key to ensuring the cream works effectively, so try to apply it simultaneously daily.

8. Can I use antifungal creams alongside other treatments?

Yes, antifungal creams can usually be used alongside other treatments, but there are exceptions. For example, combining antifungal creams with steroid creams can sometimes cause side effects like thinning of the skin. Always check with your doctor or pharmacist before combining treatments, especially if you’re using other prescription medications or have pre-existing health conditions.

9. Are there any side effects to using antifungal creams?

While antifungal creams are generally safe, some people may experience mild side effects such as skin irritation, redness, or itching at the application site. These reactions are usually temporary and may go away after continued use. If you experience severe irritation or an allergic reaction, such as swelling or blistering, stop using the cream immediately and seek medical advice.

10. Can antifungal creams be used to prevent infections?

Antifungal creams are primarily used to treat active infections, but they can sometimes be used as a preventative measure, particularly for people at high risk of fungal infections (e.g., athletes and those with compromised immune systems). However, they should only be used as directed by your doctor or pharmacist. Overuse of antifungal creams can lead to resistance or skin irritation, so it’s essential to use them appropriately.