General Properties / Mechanism of Action of AZOLES (CLASS)
Azoles block lanosterol 14α demethylase leading to decreased ergosterol synthesis & impairment of fungal cell wall function, thereby arresting fungal growth (fungistatic >> fungicidal)
Spectrum of Activity of Topical Azoles (CLASS)
- Antifungal: dermatophytes & yeasts
- Antibacterial: many azoles have some gram-positive coverage
- Anti-inflammatory properties (some azoles): decrease neutrophil chemotaxis, decrease lymphocyte synthesis, decrease histamine release, inhibition of calmodulin, inhibition of 5-lipoxygenase (which reduces leukotrienes)
General Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Indications of AZOLES (CLASS)
- Tinea (dermatophyte) infections, candida, as well as pityriasis versicolor; also used for seborrheic dermatitis due to effect on Malassezia spp.
Specific Medications
Formulation
- 1% cream, 1% lotion, oral troches (lozenge), intravaginal tablet
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: some gram-positive coverage
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Other
- Oral troches: slowly dissolve in the mouth, use 4-5x per day for 2 weeks.
Intravaginal tablet: once daily for 1-2 days
Formulation
- 2% cream, ointment, spray, powder, solution, gel
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: some gram-positive coverage
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Other
* For further reading refer to a pharmacology source
Formulation
- 2% cream, shampoo 1% (over the counter), 2% shampoo, oral solution, foam
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: minimal
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely) – allergic contact dermatitis in ketoconazole is due to sodium sulfite or propylene glycol
Other
- Utilized in Seborrheic dermatitis
- Anti-inflammatory potency similar to HC1%
Formulation
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: minimal
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Other
- Once daily administration
Formulation
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: some gram-positive coverage
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely) – allergic contact dermatitis to vehicle
Other
* For further reading refer to a pharmacology source
Formulation
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: some gram-positive coverage, also some gram-negative properties
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Other
* For further reading refer to a pharmacology source
Formulation
- 2% cream, powder, gel, solution, intravaginal tab
Spectrum of Activity
- Antifungal: dermatophytes & yeasts
- Antibacterial: some gram-positive coverage
- Anti-inflammatory properties
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely)
Other
* For further reading refer to a pharmacology source
Formulation
Spectrum of Activity
- Dermatophytes > Candida (weak)
Adverse Effects
- Burning, erythema, maceration, allergic contact dermatitis (rarely), cellulitis (rare)
Other
- Tinea corporis: daily for 1 week
- Tinea pedis: daily for 2 weeks
Formulation
Spectrum of Activity
- Dermatophytes > Candida (weak)
Adverse Effects
- Burning, erythema, maceration
Other
- Apply to affected nails once a day for 48 weeks
- Approved for dermatophyte onychomycosis (mild / moderate without lunula involvement)
