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# 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)

## Key points

- Ringworm of the skin (corporis, cruris, pedis) usually responds to a topical; ringworm of the scalp usually needs antifungal tablets and shampoo.
- Nail infections need months of a nail medicine brushed on, or antifungal tablets if that fails.
- Azoles and ciclopirox also cover Candida and Malassezia; tolnaftate does not cover Candida.
- Treatment continues for some time after the skin clears, to prevent relapse.
- Absorption is minimal, but topical econazole can still raise the INR with warfarin over large or occluded areas.

## Drugs in this class

- [**Econazole** Topical imidazole cream for ringworm, athlete's foot, skin Candida and pityriasis versicolor; it stays in the skin and… Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme)](https://durgical.com/en/pharmacology/econazole/)
- [**Efinaconazole** Topical triazole solution for fungal toenail infection (onychomycosis); applied daily for about a year to the toenails… Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme)](https://durgical.com/en/pharmacology/efinaconazole/)
- [**Tolnaftate** Topical thiocarbamate for athlete's foot, jock itch and ringworm of the body; sold without prescription as cream… Dermatophyte fungi and Malassezia in the outer skin layer](https://durgical.com/en/pharmacology/tolnaftate/)

## 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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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ECONAZOLE NITRATE cream](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=74e5bbc9-eaea-405e-b64b-b3527c5ea084) (DailyMed (U.S. National Library of Medicine), 2026); [Tolnaftate: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682617.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Ringworm](https://www.nhs.uk/conditions/ringworm/) (NHS, 2026); [Fungal nail infection](https://www.nhs.uk/conditions/fungal-nail-infection/) (NHS, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/topical-antifungals/