What are azoles and how can they help you?

What are the available antifungal creams in Malaysia?

Do you suffer itchy, inflamed skin because of fungal infections? Are you looking for an antifungal cream in Malaysia?

There are a variety of options to treat fungal problems. Among the most effective treatments are a group of antifungal medicines called azoles. Azoles work by inhibiting an enzyme in the fungal cell membrane, eventually resulting in the death of the cell1.

Researchers were aware of the antifungal activity of azoles since 1944, but it wasn't until the late '50s and '60s that azoles became available as topical antifungals. There are many different kinds of azoles, with newer kinds developed well into the '90s and beyond2.

Some azole medications, especially the older ones, may cause strong side effects. Some people may also be allergic or have allergic reactions to azoles. Because of this, it is important to consult with your doctor before trying any new medications.

Some kinds of azoles used for fungal infections

There are numerous azole medicines that are used to address fungal problems. These are just a few of them:

Clotrimazole

Clotrimazole is a broad spectrum azole antifungal used most often for the treatment of fungal infections like athlete's foot, fungal nail infection, thrush, and vaginal infections3, 4.

Clotrimazole works by curbing the cell division and growth of the organism. Although quite rare, there are strains of fungi naturally resistant to this agent, such as Candida guilliermondi5.

Yeast infections during pregnancy can safely be treated with clotrimazole. Such infections are common in pregnancy due to hormone fluctuations, which affect the vaginal pH6

Clotrimazole is also used to treat other common fungal infections, such as ringworm, which creates redness and itching, and white spot or tinea versicolor, which causes discolored patches to appear on skin7, 8, 9.

Clotrimazole is available as a cream. Because of its action against vaginal thrush or yeast, clotrimazole is also used in vaginal tablets, which are inserted inside the vagina using an applicator10.

Bifonazole

Bifonazole is another azole antifungal agent11. It comes with a strength of 1% as a cream.

It is an effective and well-tolerated antifungal that can be used against dermatophytes, molds, yeasts, dimorphic fungi, and some Gram-positive bacteria.

Compared with a lot of other topical antifungal medication, which have to be applied at least twice a day, bifonazole only needs to be administered once a day. This can help those with fungal infections stick to their treatment, as having to apply it only once a day is easier and more convenient12.

Moreover, a study looking at human clinical trials as well as animal models found that bifonazole had an anti-inflammatory effect on the skin13.

Ketoconazole

Ketoconazole is used to treat fungal infections as well as preventing them from recurring. It is available as a cream, shampoo, or foam.

It may be used for various conditions including athlete's foot, jock itch, intertrigo or sweat rash, and tinea versicolor, when small patches of skin may change color. It is also used to treat dandruff14.

Ketoconazole is an older azole drug. Compared to the newer ones, it shows significant toxicity15. Because of this, it is recommended to only use ketoconazole when you are not able to use other kinds of antifungal medications. Application of ketoconazole may cause irritated or red skin. Use can also cause harm to your liver, as well as heart16.

Miconazole

Miconazole is available as a cream, tincture, gel, vaginal suppository, or powder. It is an azole antifungal that can treat infections such as oropharyngeal candidiasis, which infects the back of the mouth and throat, and volvovaginal candidiasis, a fungal infection of the vulva and vagina.

These conditions may be opportunistic infections which may occur in people with HIV. Because of this, the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV includes recommendations for the use of miconazole for people with HIV17.

It may also be used for other mucosal yeast infections18.

Fluconazole

Flucanozole is an azole antifungal that may be used to treat yeast infections in the mouth, throat, esophagus, abdomen, lungs, blood, vagina, and other organs. It can also be used to treat meningitis, which is an infection of the membranes in the brain19

This medication may be used to prevent yeast infections in people who are undergoing chemotherapy or radiation therapy.

It comes in the form of a tablet that may be taken once a day, or an infection.

Don’t forget to consult with your doctor when looking for the best antifungal cream for your condition. Treatment duration with azole antifungals for different kinds of fungal infections vary, sometimes lasting a few weeks. But with consistent use of medication, you should see your fungal infection clearing up without recurrence.

References:

  1. Drugs.com. "Azole antifungals". Published n.d. Available at: https://www.drugs.com/drug-class/azole-antifungals.html. Accessed March 31, 2022
  2. Maertens, J. "History of the development of azole derivatives". Clinical Microbiology and Infection. Published January 1, 2004. Available at: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)30053-7/fulltext. Accessed March 31, 2022
  3. NHS. "Clotrimazole". Last reviewed Sept 16, 2019. Available at: https://www.nhs.uk/medicines/clotrimazole/. Accessed March 31, 2022
  4. PubChem. "Compound Summary: Clotrimazole". Published n.d. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/2812#section=WHO-Essential-Medicines. Accessed March 31, 2022
  5. DailyMed. “CLOTRIMAZOLE cream”. Published n.d. Updated August 2, 2010. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo. Accessed May 11, 2022
  6. Mayo Clinic. “Yeast infection during pregnancy: over-the-counter treatment OK?” Published January 6, 2021. Available at: https://www.mayoclinic.org/diseases-conditions/vaginitis/expert-answers/yeast-infection-during-pregnancy/faq-20058355. Accessed May 11, 2022
  7. Center for Disease Control and Prevention. “Fungal Diseases - Ringworm”. Published n.d. Available at: https://www.cdc.gov/fungal/diseases/ringworm/index.html. Accessed May 11, 2022
  8. Mayo Clinic. “Tinea versicolor”. Published n.d. Available at: https://www.mayoclinic.org/diseases-conditions/tinea-versicolor/symptoms-causes/syc-20378385. Accessed May 11, 2022
  9. Cleveland Clinic. “Tinea Versicolor”. Last reviewed Apr. 13, 2022. Available at: https://my.clevelandclinic.org/health/diseases/17719-tinea-versicolor. Accessed May 11, 2022
  10. Cleveland Clinic. “Clotrimazole vaginal tablets”.Published n.d. Available at: https://my.clevelandclinic.org/health/drugs/19326-clotrimazole-vaginal-tablets. Accessed May 11, 2022
  11. Meyler's Side Effects of Drugs (Sixteenth Edition). "Antifungal azoles and other antifungal drugs for topical use". Published 2016. Available at: https://www.sciencedirect.com/science/article/pii/B9780444537171003127. Accessed March 31, 2022
  12. Lackner, T., Clissold, S., "Bifonazole. A review of its antimicrobial activity and therapeutic use in superficial mycoses". PubMed.gov. Published August 1989. Available at: https://pubmed.ncbi.nlm.nih.gov/2670516/. Accessed March 31, 2022
  13. Huth, L. Marquardt, Y., et. al., “Bifonazole Exerts Anti-Inflammatory Effects in Human Three-Dimensional Skin Equivalents after UVB or Histamine Challenge”. Skin Pharmacology and Physiology. Published (online) Sept. 11, 2019. Available at: 10.1159/000502213. Accessed May 24, 2022
  14. NHS. “Ketoconazole”. Last reviewed June 24, 2021. Available at: https://www.nhs.uk/medicines/ketoconazole/. Accessed March 31, 2022
  15. Nett, J., Andes, D., “Antifungal Agents Spectrum of Activity, Pharmacology, and Clinical Indications”. Infectious Disease Clinics of North America. Published March 2016. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0891552015001014?via%3Dihub. Accessed March 31, 2022
  16. Drugs.com. "Ketoconazole". Reviewed Feb 14, 2022. Available at: https://www.drugs.com/mtm/ketoconazole.html. Accessed March 31, 2022
  17. Clinical Info HIV.gov. "Drug Database: Miconazole". Last reviewed March 17, 2021. Available at https://clinicalinfo.hiv.gov/en/drugs/miconazole/patient#dr2. Accessed March 31, 2022
  18. PubChem. "Compound Summary: Miconazole". Published n.d. Available at https://pubchem.ncbi.nlm.nih.gov/compound/Miconazole. Accessed March 31, 2022
  19. MedlinePlus. "Fluconazole". Last revised Dec 15, 2018. Available at: https://medlineplus.gov/druginfo/meds/a690002.html. Accessed March 31, 2022