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Abstract

Superficial fungal infections of the skin are very common, with topical antifungal therapy considered the first-line treatment. Many topical antifungals are available that are high in efficacy and low in systemic adverse effects. Azole antifungals such as miconazole, clotrimazole, and ketoconazole are well known and have been used extensively for dermatophytoses. Miconazole and clotrimazole are effective in treating cutaneous candidiasis, while ketoconazole is effective in treating seborrheic dermatitis. Newer azoles to emerge include luliconazole and efinaconazole, with luliconazole approved for tinea corporis, tinea cruris, and tinea pedis, and efinaconazole approved for onychomycosis (along with tavaborole, a new agent with a novel mechanism of action). Allylamine/benzylamine antifungals include naftifine, terbinafine, and butenafine. All are effective in treating dermatophyte infections, whereas terbinafine and butenafine have shown efficacy against Candida infections as well, although an indication against Candida has not been pursued. Ciclopirox (indicated for superficial tinea, onychomycosis, and cutaneous candidiasis) and selenium sulfide for seborrheic dermatitis of the scalp and pityriasis versicolor round out the arsenal of topical antifungal options for treatment of superficial fungal infections. All topical antifungals are relatively safe and well tolerated with application site reactions (e.g., pruritus) the most common adverse events.