Tinea Cruris Medication

Updated: Sep 11, 2020
  • Author: Michael Wiederkehr, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

To achieve the best results, particularly with follicular or extensive tinea cruris, the authors often recommend a combination of topical and systemic therapy. [13]  

The two classes of antifungal medications used most commonly to treat tinea cruris are the azoles and the allylamines. Azoles inhibit the enzyme lanosterol 14-alpha-demethylase, an enzyme that converts lanosterol to ergosterol, which is an important component of the fungal cell wall. Membrane damage results in permeability problems and renders the fungus unable to reproduce. Allylamines inhibit squalene epoxidase, which is an enzyme that converts squalene to ergosterol, resulting in the accumulation of toxic levels of squalene in the cell and in cell death. Examples of both classes of antifungal agents are available for topical and systemic administration. Some data suggest that fungistatic azoles can be as effective as fungicidal allylamines. [14] Both may have depot effects in the stratum corneum. [15]

Studies have found terbinafine to be effective and well tolerated in children. [16] Terbinafine 1% emulsion gel was found to be more effective than ketoconazole 2% cream in the treatment of tinea cruris. [17]

There may be some advantage to giving itraconazole with whole milk to increase absorption.14 However, because of its metabolism, drug interactions with inhibitors of cytochrome P450 are possible. [18]

Haloprogin is an agent for use in the treatment of tinea cruris. It is prescription only and is available in 1% cream and solution/spray. It is not available in the United States.

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Antifungal agents

Class Summary

The mechanism of action usually involves inhibiting pathways (enzymes, substrates, transport) necessary for sterol/cell membrane synthesis or altering the permeability of the cell membrane (polyenes) of the fungal cell.

Terbinafine (Lamisil)

Terbinafine is a synthetic allylamine derivative, which inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi that results in a deficiency of ergosterol, causing fungal cell death. It is a widely studied and effective topical or oral antifungal. The topical form is available without a  prescription. Some clinicians reserve this drug for more widespread/resistant infections because of its broad coverage and increased cost. Studies have found this medication to be effective and well tolerated in children.

Butenafine (Mentax)

Butenafine is a potent antifungal related to the allylamines. It damages fungal cell membranes, causing fungal cell growth to arrest. It is available in 1% cream only.

Clotrimazole topical (Lotrimin, Mycelex)

Clotrimazole topical is often the first-line drug used in the treatment of tinea cruris. It is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing the death of fungal cells. Reevaluate the diagnosis if no clinical improvement after is seen after 4 weeks. It is available without a prescription in 1% cream, solution/spray, and lotion.

Miconazole (Micatin, Monistat-Derm)

Miconazole damages the fungal cell wall membrane by inhibiting the biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak, resulting in fungal cell death. It is available without a prescription, and 2% cream, solution/spray, lotion, and powder forms are available. Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.

Ketoconazole topical (Nizoral)

Ketoconazole topical comes as 2% cream. It is an imidazole broad-spectrum antifungal agent; it inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.

Econazole topical (Ecoza)

Econazole is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. It disrupts fungal cell wall permeability, causing fungal cell death.

Luliconazole (Luzu)

Luliconazole is an imidazole antifungal that alters the fungal cell membrane by interacting with 14-alpha demethylase (an enzyme necessary for conversion of lanosterol to ergosterol). It is indicated for tinea cruris caused by the organisms Trichophyton rubrum and Epidermophyton floccosum in adults and children aged 12 years or older. It is available as a 1% topical cream.

Naftifine (Naftin)

Naftifine is a broad-spectrum antifungal agent and synthetic allylamine derivative; it may decrease the synthesis of ergosterol, which, in turn, inhibits fungal cell growth. It is available in 1% cream or solution. If no clinical improvement is seen after 4 weeks, reevaluate the patient.

Oxiconazole (Oxistat)

Oxiconazole is a broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. It is available in 1% cream or lotion.

Tolnaftate (Tinactin)

Tolnaftate is a nonprescription medication used in the treatment of tinea cruris. It is available in 1% cream, solution/spray, and powder.

Ciclopirox (Loprox)

Ciclopirox is a synthetic broad-spectrum antifungal agent. It interferes with the synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells. It is available by prescription only in 1% cream and lotion.

Itraconazole (Sporanox)

Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P450–dependent synthesis of ergosterol, a vital component of fungal cell membranes. It is a widely used and well-studied oral antifungal that can be used in the treatment of tinea cruris. Studies have shown that it is tolerated better than griseofulvin. Best results are noted 2-3 weeks after the end of treatment.

Sulconazole (Exelderm)

Sulconazole is a broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. It is available as 1% cream or solution.

Griseofulvin (Fulvicin-U/F, Grifulvin-V)

Griseofulvin has fungistatic activity. Fungal cell division is impaired by interfering with microtubules. It binds to keratin precursor cells. Keratin gradually is replaced by noninfected tissue, which is highly resistant to fungal invasions. It is less effective than itraconazole in the treatment of tinea cruris.

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