VA Class:DE102
ATC Class:D01AE18
Tolnaftate is a synthetic thiocarbamate antifungal agent.
Tolnaftate is used topically for the treatment of certain dermatophytoses, including tinea corporis (body ringworm),109 tinea cruris (jock itch),110, 111 tinea pedis (athlete's foot), and tinea manuum† (hand ringworm), caused by Epidermophyton floccosum , Microsporum audouini , M. canis , Trychophyton mentagrophytes , T. rubrum , or T. tonsurans .109, 110, 111
Tolnaftate may be used for self-medication (nonprescription, over-the-counter use) for treatment of tinea corporis,109 tinea cruris,110, 111 and tinea pedis and to prevent reinfection of tinea pedis.109, 110, 111
Tolnaftate should not be used for treatment of dermatophyte infections that occur on the scalp or nails.109, 110, 111
Tinea Corporis and Tinea Cruris
Tinea corporis and tinea cruris generally can be effectively treated using a topical antifungal; however, an oral antifungal may be necessary if the disease is extensive, dermatophyte folliculitis is present, the infection is chronic or does not respond to topical therapy, or the patient is immunocompromised because of coexisting disease or concomitant therapy.100, 101, 104, 105, 106
Many clinicians consider topical imidazole-derivative azole antifungals (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole) or topical allylamine antifungals (e.g., naftifine, terbinafine) the drugs of first choice for the topical treatment of tinea corporis or tinea cruris,101, 108 although other antifungals (e.g., ciclopirox olamine, butenafine hydrochloride, tolnafate, undecylenic acid) also can be effective in the treatment of these infections.100, 101, 104, 105, 106
Uncomplicated interdigital and vesiculobullous forms of tinea pedis and tinea manuum† generally can be treated effectively using a topical imidazole-derivative azole antifungal (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole), an allylamine antifungal (e.g., naftifine, terbinafine), or other topical antifungal such as ciclopirox olamine, butenafine hydrochloride, tolnaftate, or undecylenic acid.100, 101, 104, 105, 106 However, an oral antifungal usually is necessary for the treatment of hyperkeratotic areas on the palms and soles,101, 106 for chronic moccasin-type (dry-type) tinea pedis,100, 101, 105 and for the treatment of tinea unguium (fingernail or toenail dermatophyte infections, onychomycosis).100, 101, 104, 105, 106
Tolnaftate is used for the treatment of pityriasis (tinea) versicolor†, a superficial infection caused by Malassezia furfur ( Pityrosporum orbiculare or P. ovale ).100
Pityriasis versicolor generally can be treated topically with an imidazole-derivative azole antifungal (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole), an allylamine antifungal (e.g., terbinafine), ciclopirox olamine, or certain other topical therapies (e.g., selenium sulfide 2.5%).100, 102, 103, 105, 107 However, an oral antifungal (e.g., itraconazole, ketoconazole) may be indicated, with or without a topical antifungal, in patients who have extensive or severe infections or who fail to respond to or have frequent relapses with topical therapy.102, 103, 105
Tolnaftate is applied topically to infected skin as a 1% cream, aerosol liquid spray, aerosol powder spray, powder, or solution.109, 110, 111
Contact with eyes, nose, mouth, and other mucous membranes should be avoided.109, 110, 111 Tolnaftate should not be used on nail or scalp infections.109, 110, 111
Prior to application, the infected area should be cleaned with soap and water and dried thoroughly.109, 110, 111
The powder or aerosol powder is used alone for the treatment of mild infections or as an adjunct to the cream or solution or systemic antifungal agents when drying of the lesion is desired.
A small amount of the cream or powder or 2 or 3 drops of the solution should be rubbed gently into affected areas.109, 110, 111 If the aerosol liquid spray or aerosol spray powder is used, a thin layer should be applied.111
When used for the treatment of tinea pedis, special attention should be paid to applying the drug in the spaces between the toes.109, 111 In addition, patients with tinea pedis should wear well-fitting, ventilated shoes and change their shoes and socks at least once daily.109, 111
For the treatment of tinea corporis, tinea cruris, or tinea pedis in adults and children 2 years of age or older, tolnaftate should be applied to affected areas twice daily (morning and night).110, 111 The usual duration of therapy is 2 weeks for tinea cruris110 or 4 weeks for tinea corporis or tinea pedis.109, 110
Although pruritus, burning, and soreness may be relieved within 24-72 hours after initiation of therapy with tolnaftate, the full course of treatment should be completed.
After treatment of tinea pedis is completed, the drug can be used daily to prevent reinfection.109, 110, 111
If improvement does not occur after 4 weeks of treatment, the diagnosis should be reevaluated. A single, 2- to 6-week course of treatment may be adequate, but second and third courses are sometimes required.
For the treatment of pityriasis (tinea) versicolor†, tolnaftate is applied twice daily (morning and night).100
Tolnaftate has a low order of toxicity and a low index of sensitization when applied topically. Slight local irritation may occur when the drug is applied to excoriated skin or when secondary, superimposed infections are present over a large area of skin. At least one case of sensitization to butylated hydroxytoluene which is present in the cream, solution, and aerosol powder formulations has been confirmed.
Precautions and Contraindications
Tolnaftate is contraindicated in patients with known hypersensitivity to the drug or any ingredient in the formulation.
If irritation or hypersensitivity occurs, or if the patient's skin disease does not improve within 10 days or becomes worse during self-medication with tolnaftate, treatment should be discontinued (unless otherwise directed) and the patient should consult a clinician or podiatrist.
Tolnaftate preparations are for external use only. Care should be taken to avoid contact with the eyes.
Intentional misuse by deliberately concentrating and inhaling the contents of the aerosols can be harmful or fatal.111
Tolnaftate should not be used in children younger than 2 years of age, unless otherwise directed by a clinician.109, 110, 111
There are no adequate and controlled studies to date using tolnaftate in pregnant women, and the drug should be used during pregnancy only when clearly needed.112
It is not known whether tolnaftate is distributed into milk. Safe use of tolnaftate in nursing women has not been established.112
The exact mode of action of tolnaftate is not known, but the drug has been demonstrated to distort the hyphae and stunt mycelial growth in susceptible fungi.
In vitro, tolnaftate is fungistatic or fungicidal against susceptible organisms. Tolnaftate is active in vitro against Microsporum audouinii , M. canis , M. gypseum , M. japonicum , Trichophyton mentagrophytes , T. rubrum , T. schoenleinii , T. tonsurans , and Epidermophyton floccosum .
Tolnaftate is inactive against Candida albicans , Cryptococcus neoformans , and most strains of Aspergillus fumigatus . The drug also is inactive against bacteria, protozoa, and viruses.
Tolnaftate is a synthetic antifungal agent and is a thiocarbamate derivative. Tolnaftate occurs as a white to creamy white, fine powder with a slight odor. The drug is practically insoluble in water, slightly soluble in alcohol, and soluble in polyethylene glycols. The commercially available tolnaftate cream, solution, and aerosols may contain butylated hydroxytoluene.
Tolnaftate cream should be stored at 20-25°C.109 The powder and topical solution should be stored in tight containers at a temperature less than 40°C, preferably between 15-30°C. These preparations should not be frozen.
Tolnaftate aerosols should be stored at 2-30°C. Because the contents of tolnaftate aerosols are under pressure, the aerosol container should not be punctured, used or stored near heat or an open flame, exposed to temperatures greater than 49°C, or placed into a fire or incinerator for disposal.111
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Aerosol | 1% | Tinactin® Liquid Aerosol | Schering-Plough |
Ting® Antifungal Spray | Insight | |||
Aerosol Powder | 1% | Tinactin® Jock Itch Spray Powder | Schering-Plough | |
Tinactin® Powder Aerosol | Schering-Plough | |||
Cream | 1%* | Tinactin® | Schering-Plough | |
Tinactin® Jock Itch Cream | Schering-Plough | |||
Ting® Antifungal Cream | Insight | |||
Tolnaftate Topical Cream | ||||
Powder | 1%* | Tinactin® | Schering-Plough | |
Tolnaftate Topical Powder | ||||
Solution | 1%* | Tinactin® | Schering-Plough | |
Tolnaftate Topical Solution |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Only references cited for selected revisions after 1984 are available electronically.
100. Gupta AK, Einarson TR, Summerbell RC et al. An overview of topical antifungal therapy in dermatomycoses: a North American perspective. Drugs . 1998; 55:645-74. [PubMed 9585862]
101. Piérard GE, Arrese JE, Piérard-Franchimont C. Treatment and prophylaxis of tinea infections. Drugs . 1996; 52:209-24. [PubMed 8841739]
102. Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor: an update. Cutis . 1998; 61:65-72. [PubMed 9515210]
103. Assaf RR, Weil ML. The superficial mycoses. Dermatol Clin . 1996; 14:57-67. [PubMed 8821158]
104. Lesher JL. Recent developments in antifungal therapy. Dermatol Clin . 1996; 14:163-9. [PubMed 8821170]
105. Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandel GL, Douglas RG Jr, Bennett JE, eds. Principles and practices of infectious disease. 4th ed. New York: Churchill Livingston; 1995: 2375-86.
106. Drake LA, Dincehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. J Am Acad Dermatol . 1996; 34:282-6. [PubMed 8642094]
107. Drake LA, Dinehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: pityriasis (tinea) versicolor. J Am Acad Dermatol . 1996; 34:287-9. [PubMed 8642095]
108. Reviewers' comments (personal observations) on Sulconazole 84:04.08.
109. Schering-Plough HealthCare Products. Tinactin (tolnaftate) cream 1% prescribing information. Memphis, TN. Undated.
110. Insight Pharmaceuticals. Ting® (tolnaftate) cream 1% prescribing information. Langhorne, PA. 2006.
111. Insight Pharmaceuticals. Ting® (tolnaftate) spray liquid 1% prescribing information. Langhorne, PA. 2006.
112. Robertson J, Shilkofski N, eds. The Harriet Lane handbook: a manual for pediatric house officers. 17th ed. Philadelphia, PA: Elsevier Mosby: 2005:987.