Cutaneous fungal infections, including cutaneous candidiasis, tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), and tinea versicolor.
Action⬆⬇
Affects the permeability of the fungal cell wall, allowing leakage of cellular contents.
Therapeutic effects:
Decreased symptoms of fungal infection.
Pharmacokinetics⬆⬇
Absorption: Absorption through intact skin is minimal.
Distribution: Distribution after topical administration is primarily local.
Metabolism/Excretion: Systemic metabolism and excretion is negligible with local application.
Half-Life: Not applicable.
Time/Action Profile⬆⬇
(resolution of symptoms/lesions)
ROUTE
ONSET
PEAK
DURATION
Top
unknown
unknown
unknown
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity to active ingredients, additives, preservatives, or bases;
Some products contain alcohol or bisulfites and should be avoided in patients with known intolerance.
Use Cautiously in:
Nail and scalp infections (may require additional systemic therapy);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding.
Adv. Reactions/Side Effects⬆⬇
Local: burning, itching, local hypersensitivity reactions, redness, stinging
Interactions⬆⬇
Drug-drug:
None significant.
Route/Dosage⬆⬇
(Adults and Children ): Apply cream, ointment, or powder 2–3 times daily until healing is complete.
Availability⬆⬇
(Generic available)
Cream: 100,000 units/g
Ointment: 100,000 units/g
Powder: 100,000 units/g
In combination with: triamcinoloneRx. See Appendix [not included in this PDA edition].
Assessment⬆⬇
Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.
Implementation⬆⬇
Do not confuse nystatin with HMG-CoA reductase inhibitors (“statins”).
Consult health care professional for proper cleansing technique before applying medication.
Ointments and creams are used as primary therapy; if cream is used, apply sparingly to avoid maceration. Powders are usually used as adjunctive therapy but may be used as primary therapy for mild conditions (especially for moist lesions).
Apply small amount to cover affected area completely. Avoid the use of occlusive wrappings or dressings unless directed by health care professional.
Patient/Family Teaching⬆⬇
Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Emphasize the importance of avoiding the eyes.
Caution patient that some products may stain fabric, skin, or hair. Check label information. Fabrics stained from cream or lotion can usually be cleaned by handwashing with soap and warm water; stains from ointments can usually be removed with standard cleaning fluids.
Patients with athlete’s foot should be taught to wear well-fitting, ventilated shoes; to wash affected areas thoroughly; and to change shoes and socks at least once a day.
Advise patient to report increased skin irritation or lack of response to therapy to health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Evaluation/Desired Outcomes⬆⬇
Decrease in skin irritation and resolution of infection. Early relief of symptoms may be seen in 2–3 days. For Candida, tinea cruris, and tinea corporis, 2 wk are needed, and for tinea pedis, therapeutic response may take 6 wk. Recurrent fungal infections may be a sign of systemic illness.