Benzylamine and Thiocarbamate Derivatives
The benzylamine group includes butenafine (Mentax), which is similar to allylamines in its spectrum and mechanism of action. This cream is applied once daily. It demonstrates high efficacy against dermatophytes and the causative agent of tinea versicolor, though it is somewhat less potent than azole compounds in treating cutaneous candidiasis.
Tolnaftate is a thiocarbamate derivative. Available as a cream, gel, solution, and powder, it is used twice daily for the treatment and prevention of mycoses. A key characteristic of tolnaftate is its complete lack of efficacy against Candida species.
Morpholine Derivatives and Halogenated Compounds
Amorolfine-based medications are morpholine derivatives. Their mechanism of action involves the inhibition of ergosterol synthesis enzymes (delta-14-reductase and delta-7-8-isomerase), leading to the accumulation of defective sterols and the disruption of the fungal cell membrane. The effect can be either fungistatic or fungicidal depending on the concentration. The primary indication for amorolfine is fungal nail infections (onychomycosis).
Haloprogin is a halogenated phenol ether available in cream and solution formulations. It is poorly absorbed through the epidermis and is metabolized in the body to trichlorophenol. It is prescribed in 2-to-4-week courses with twice-daily application for dermatophytoses and tinea versicolor.
Ciclopirox and Other Topical Antifungals
Ciclopirox (Batrafen) exhibits pronounced fungicidal effects. Its variety of dosage forms is extensive:
- Cream, gel, suspension, lotion: prescribed for tinea versicolor, cutaneous mycoses, and vaginal candidiasis.
- Nail lacquer: used for onychomycosis.
- Shampoo (1%): effective for scalp seborrheic dermatitis.
Other notable agents include undecylenic acid preparations (found in ointments such as zincundan, undecin, and mycoseptin), as well as the topical antiseptic potassium iodide. Dequalinium chloride also warrants special mention as a bis-quaternary ammonium compound with dual action (antibacterial and fungicidal). It is used as an ointment for skin infections and as lozenges for throat inflammation and candidal stomatitis.