Topical antifungals

Creams, solutions and powders applied to skin or nails for ringworm, athlete's foot, Candida and pityriasis versicolor, with little reaching the blood.

Updated Nov 12, 2026

What they are

Antifungals made to act where they are applied. Several chemical groups are used: imidazoles (clotrimazole, miconazole, ketoconazole, econazole), a topical triazole for nails (efinaconazole), allylamines (terbinafine, naftifine), the thiocarbamate tolnaftate, ciclopirox and the polyene nystatin. Because so little is absorbed, they cause few systemic effects and few drug interactions; their main problems are local irritation and the long courses that nails need.

Mechanism of action

Most block ergosterol, the sterol of the fungal membrane. Azoles inhibit lanosterol 14α-demethylase (CYP51); allylamines inhibit squalene epoxidase earlier in the pathway, so squalene builds up and ergosterol runs out. The membrane leaks and the fungus stops growing. Polyenes bind ergosterol directly, and ciclopirox chelates metals that fungal enzymes need. Tolnaftate, a thiocarbamate, also stops dermatophyte growth.

Target: Fungal cell membrane and ergosterol synthesis (CYP51 for azoles; squalene epoxidase for allylamines)

Drugs in this class

Others in the class

clotrimazole (topical)
miconazole (topical)
ketoconazole (topical)
terbinafine (topical)
naftifine
butenafine
ciclopirox
nystatin (topical)
tavaborole

Test yourself

Think of the answer, then tap the question to see it.

Which enzyme do the topical azoles block, and which do the allylamines block?

Azoles block lanosterol 14α-demethylase (CYP51); allylamines block squalene epoxidase.

Which form of ringworm usually needs tablets rather than a cream?

Ringworm of the scalp (tinea capitis), treated with antifungal tablets and shampoo.

Why is treatment continued after the skin looks clear?

Fungi remain in the outer skin layer for a while; stopping early allows relapse.

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