List of Topical Antifungals Uses, Types — Side Effects

Topical antifungals

What are Topical antifungals?

Topical antifungals are products that treat fungal infections and which are applied directly to the skin, nails, or hair; vaginally; or inside the mouth. They are available as creams, gels, lotions, nail lacquers, ointments, powders, shampoos, sprays, and tinctures.

Fungal infections are caused by dermatophytes, yeasts, or molds.

There are about 40 different species of dermatophyte, and they obtain their nutrients from keratinized material, so typically are the organisms responsible for fungal infections of the skin, scalp or nails.

Yeasts are normal inhabitants of our skin but sometimes they grow unheeded which can result in symptomatic infections. Molds are an uncommon cause of fungal infections but they can cause tinea nigra (painless brown or black patches on the skin) or hard-to-treat nail infections.

Most antifungal agents treat both dermatophyte and yeast infections; however, some, such as nystatin, are not suitable for dermatophyte fungal infections.

What are topical antifungals used for?

Topical antifungals may be used to treat fungal infections of the skin, scalp, mucous membranes, nails, and vagina. Examples of infections that topical antifungals may treat include:

  • Candida infections
  • Nail infections
  • Pityriasis versicolor (causes flaky, discolored patches of skin)
  • Tinea barbae (fungal infection of the beard and mustache area)
  • Tinea capitis (fungal infection of the scalp)
  • Tinea corporis (ringworm)
  • Tinea cruris (jock itch)
  • Tinea faciei (facial fungal infection)
  • Tinea manuum (fungal infection of the hands)
  • Tinea nigra
  • Tinea pedis (fungal infection of the foot).

Other fungal infections not listed here may also be treated with topical antifungals.

What are the differences between topical antifungals?

Antifungal agents may be classified into a number of different types, depending on their structure and the way that they work. Many topical antifungals work by inhibiting production of ergosterol, a fundamental component of the fungal cell membrane and wall.

Note that only the antifungals that are available topically are listed here.

Azole antifungals

Azole antifungals are further classified into imidazoles and triazoles. Although all azoles work in the same way (by inhibiting an enzyme that converts lanosterol into ergosterol), there are differences in the spectrum of activity between imidazoles and triazoles.

Azole antifungals are metabolized through cytochrome p450 liver enzymes and are particularly susceptible to clinically-significant drug interactions with other medications metabolized through the same pathway, although this tends to only apply to topical products used inside the mouth, such as miconazole oral gel.

Generic name Brand name examples
Imidazoles
clotrimazole FungiCURE, Lotrimin
econazole Ecoza, Spectazole
ketoconazole Nizoral topical
miconazole Azolen, Zeasorb
miconazole/zinc oxide Rash Relief Antifungal, Vusion
oxiconazole Oxistat
sertaconazole Ertaczo
tioconazole 1-day, Vagistat-1
Triazoles
efinaconazole Jublia

Polyene antifungals

Polyenes work by binding to ergosterol, disrupting the integrity of the fungal cell membrane. Nystatin is the only polyene antifungal available topically. Note that nystatin is not effective against dermatophyte infections but can be used to treat Candida infections.

Generic name Brand name examples
nystatin Mycostatin topical, Nyamyc

Allylamine antifungals

Allylamines work in a similar way to azoles but have their effect earlier on in the ergosterol synthesis pathway. They inhibit the enzyme squalene epoxidase which converts squalene into ergosterol, disrupting synthesis of the fungal cell wall.

Terbinafine is also metabolized by cytochrome p450 liver enzymes and is particularly susceptible to clinically-significant drug interactions with other medications metabolized through this pathway, although this tends not to apply to topical products.

Generic name Brand name examples
amorolfin Not available in the U.S.
naftifine Naftin
terbinafine Lamisil

Other antifungals

Several other topical antifungals are available. Their mechanism of action differs to the antifungals listed above.

Generic name Brand name examples
Benzoic acid and salicylic acid Bensal HP
ciclopirox Ciclodan, Loprox
tavaborole Kerydin
tolnaftate Tinactin
undecylenic acid Blis-To-Sol, Protectol

Are topical antifungals safe?

Topical antifungals are considered safe when used exactly as directed according to the product label. However, certain topical antifungals have been associated with serious side effects, for example:

  • Miconazole oral gel: Should not be used in infants with an impaired swallowing reflex or in preterm infants in their first six months of life, or in babies less than four months old, because of the potential for airway obstruction
  • Miconazole oral gel: May also cause clinically significant interactions with medicines (such as warfarin) metabolized through the same liver pathway because miconazole oral gel is absorbed through the mouth.

For a complete list of severe side effects, please refer to the individual drug monographs.

What are the side effects of topical antifungals?

Not everybody will experience side effects from topical antifungals. Some of the more commonly reported side effects include:

  • Burning or stinging
  • Rash
  • Sensitivity reactions
  • Skin irritation (redness, peeling, swelling).

Some vaginal topical antifungal preparations have been associated with burning, cramping, itching, pain, and bleeding.

For a complete list of side effects, please refer to the individual drug monographs.

www.drugs.com

Expert Health Reviews

Self-Help Tips From Dr Sarah Brewer

Self-Help Tips From Dr Sarah Brewer

Best Pain Relief Creams & Gels For Muscles & Joints

Last updated by Dr Sarah Brewer on August 7, 2019

As a doctor I’ve tried, recommended and prescribed many pain-relieving creams and gels to treat painful joints, backache, sore muscles, strained tendons and sprained ligaments. Medical guidelines even recommend that doctors prescribe topical creams and gels to treat mild to moderate joint pain. The best pain relief creams and gels are often just as effective as oral painkillers, but with much less risk of side effects. When I experience muscle or joint pain, I prefer to use a pain relief cream myself.

Quick links: These are the best pain relief creams and gels that I recommend on Amazon.co.uk or Amazon.com .

How pain relief cream and pain relief gel works

Pain relief cream and pain relief gel work in several ways to reduce discomfort. You were probably told as a child to ‘rub it better’ when you hurt yourself as this simple action quickly reduces the discomfort of knocks and sprains by flooding the brain with sensory messages from this area.

The sensation of rubbing literally helps to drown out any pain messages coming from that area. In the same way, the physical action of massaging in a cream or gel stimulate touch receptors and other nerve endings which send signals to the brain. This overwhelms messages from pain receptors so their signals are less likely to get through.

Massaging in a pain cream also warms the underlying area, and increases blood flow so the active ingredients can sink into the skin more readily, getting to work to relieve your pain. Massaging in a cream also increases blood flow, bringing in natural healing factors and flushing away the inflammatory chemicals that lead to pain.

Finally, the active ingredients within a pain relief cream interact with local nerve endings to damp down inflammation, reduce pain and swelling and ease stiffness. All these different actions make topical, rub-in creams and gels highly effective for treating painful joints, sore muscles and sport injuries. Here, I’ve reviewed what I believe are the best pain relief creams, sore muscle creams and pain relief gels.

Which is the best pain relief cream for sore muscles and joints?

Different creams and gels combine different pain-relieving ingredients for a greater, synergistic effect. The most effective natural ingredients are arnica, cannabidiol CBD oil, glucosamine, chondroitin, celadrin, comfrey root, capsicum, MSM and Green-lipped mussel extracts. The most effective pharmaceutical pain relief gel are those containing diclofenac, which is a stronger version of ibuprofen.

If you’re looking for the best pain relief cream for back pain, then Penetrex is the one with the highest number of 5* reviews in the US, which you can read here .

In the UK, one of the best pain relief creams is Hemp Pain Relief Cream while the most popular gels are Hemp Active Gel or the more pharmaceutical Voltarol Back and Muscle Pain Relief gel (see diclofenac review further down).

Arnica cream and gel for pain relief

Arnica montana is a flowering mountain herb with a long history of traditional use in pain relief. Arnica extracts contain numerous pain reliefing ingredients, including sesquiterpene lactones, flavonoids which reduce inflammation, swelling and pain, plus thymol which fights infection. Arnica cream, gel and ointment is used to ease muscle pain and spasm, insect bites, superficial burns – including sunburn – sprains and painful joints caused by arthritis or other rheumatic disorders. Herbal arnica products contain measurable levels of active ingredients, while homeopathic arnica products contain lower levels that work in a different way. Research shows that arnica products are as effective at relieving painful joints as ibuprofen gel when applied two to four times a day.

A study involving 172 people with osteoarthritis of the knee compared the use of a arnica gel with a prescribed, nonsteroidal anti-iflammatory gel (the NSAID piroxicam) with 1g of gel applied three times a day for 4 weeks. The results showed a pain reduction of 16.5 in the arnica gel group versus only 8.1 in the NSAID gel group and the researchers concluded that the Arnica gel was at least as effective and as well tolerated as the NSAID gel. A similar trial involving over 200 people with osteoarthritis of the hands showed that arnica gel was just as effective as an NSAID (ibuprofen) gel in reducing pain and improving hand function.

Cannabidiol CBD salve and ointment for pain relief

Cannabidiol, or CBD, is extracted from non-marijuana strains of industrial hemp plants. CBD oil is one of the most popular supplements for pain when taken orally, and CBD creams, salves and ointments are equally effective for pain relief when applied directly to painful muscles and joints. CBD is absorbed through the skin to interact with cannabinoid receptors (CB2) and suppress inflammation, relieve local pain and reduce itching, irritation and soreness. You can use a CBD salve or ointment at the same time as taking CBD oil capsules which reduce pain perception within the brain, aid relaxation and sleep as well as reducing discomfort and fatigue. Click here to find out more about oral cannabidiol CBD oil supplements for pain.

The CBD salves and ointments I like best only contain natural ingredients with no synthetic fragrances or artificial preservatives.

Carun Active Hemp Ointment is an infusion of cannabidiol CBD in petroleum jelly, hemp seed oil and olive oil, and is scented with a blend of natural lemon, peppermint and lavender essential oils. This ointment contains CBD at a strength of 3% (a 100ml pot contains 300mg CBD) and has a soft, melting texture at room temperature. Carun Active Hemp Ointment is available from Amazon.co.uk . A wide range of CBD ointments and creams are also available on Amazon.com some of which combine CBD with Arnica for additional healing benefits.

The strongest CBD cream is Recover Inflammation Formula which, although not cheap, has a reputation for relieving pain quickly.

Glucosamine pain relief cream and gel

The glucosamine found in topical creams and gels is different to the glucosamine found in oral tablets. This form, n-acetyl glucosamine, is small enough to sink into skin and penetrate underlying tissues to reduce pain. Glucosamine provides building blocks for the production of synovial fluid, making it thicker and more cushioning.

Synovial fluid is a thick, slippery substance with a consistency similar to egg white. It acts like an oil and fills small cavities within the joint cartilage, providing oxygen and nutrients when the joint is resting. Synovial fluid also pushes the bones apart so they don’t rub together to cause pain. Glucosamine also provides building blocks for making new cartilage, and repairing damaged areas. Glucosamine is also known to damp down inflammation and act as a biological signal to stimulate tissue repair.

Topical glucosamine cream and gel can significantly reduce the pain of knee osteoarthritis within 4 weeks. One study involving a glucosamine cream found that 100% of those with arthritis of the shoulder gained benefit. Of those with arthritis of the ankle, wrist or elbow, glucosamine cream reduced pain in 75% of people, and it worked in 58% of those with knee osteoarthritis.

If you prefer a cream, I recommend Flexable Glucosamine Cream which incldes chondroitin and MSM. If you prefer a gel, I recommend Optima Glucosamine Joint Complex Gel or Healthspan Glucosamine & Magnesium Gel which includes additional magnesium to ease both sore joints and sore muscles. (Disclaimer: I act as a medical consultant to Healthspan ).

Chondroitin pain relief cream

Chondroitin sulphate is produced naturally in the body to promote the formation of healthy cartilage, tendons and ligaments, and it is also an important component of joint synovial fluid. As you get older, your joint cells secrete less and less chondroitin and this has been linked with reduced cartilage quality and the start of degenerative changes.

Chondroitin sulphate chains bind to hyaluronic acid to form ‘springy’ molecules that increase the strength and elasticity of cartilage, making it more resilient. Chondroitin also acts as a signal to inhibit the enzymes responsible for breaking down cartilage, and to increase the production of collagen. Chondroitin is therefore an ideal complement to glucosamine and the two are often combined in joint and muscle pain relief creams.

A study involving 63 people with osteoarthritis found that applying a knee pain cream containing both glucosamine and chondroitin produced greater pain reduction than a placebo cream. After 4 weeks, the active glucosamine and chondroitin cream was 20% more effective, and after 8 weeks, it was 80% more effective than the placebo cream.

Celadrin pain relief cream

Celadrin is a blend of waxy, cetylated fatty acids (CFAs) that are laid down in cell membranes to improve their flexibility and resilience. It also has an anti-inflammatory, pain-killing action.

Cetylated fatty acids are unusual in that they only occur in two places in nature – in sperm whale oil and in a strain of mice renowned for their immunity against arthritis. The celadrin in inflammation cream for muscle and joint pain is derived from monounsaturated fats found in olive oil, however.

Research shows that applying celadrin cetylated fatty acid cream with menthol to knees can reduce arthritis pain and improve the range of movement. Applying celadrin cream also makes it easier to climb up and down stairs. Celadrin cream cetylated fatty acids is also effective as a muscle pain relief cream to treat pain associated with trigger points in the neck.

Celadrin cream works really well when you rub it all the way around a painful joint, such as the knee, rather than just on the front or back of the joint. A good way to prove to yourself that it is working is to apply it to one joint (eg left knee) and not the other (eg right knee) three times a day for 10 days and you will notice a difference.

Many patients have told me they find celadrin cream effective for rapid relief of painful joints. It appears to work best when you apply it all around the joint – for example in a continuous band around the front, sides and back of a knee. One patient, who had two arthritic knees, told me he performed a personal experiment in which he applied celadrin cream around one knee but not the other. He was amazed at the difference in the treated knee which, within hours, became less painful and more mobile. Needless to say, he soon started applying it to both knees!

See the best celadrin containing creams at Amazon.co.uk or Amazon.com .

MSM pain relief cream

MSM (methyl-sulfonyl-methane) is a naturally rich source of sulphur which is a vital constituent of connective tissues and structural proteins. It is essential for the repair of muscles, joints and ligaments and has a powerful antioxidant and anti-inflammatory action.

With increasing age, skin and joint tissues tend to lose its elasticity due to the formation of cross-linkages within collagen. MSM may help to maintain suppleness of tissues by blocking the formation of these abnormal cross-linkages. MSM is an effective sore muscle cream and is often combined with glucosamine and chondroitin.

See the best MSM containing creams at Amazon.co.uk or Amazon.com .

Comfrey pain relief ointment

Comfrey root has a long history of traditional use to heal wounds and fractures when applied as a poultice, and was commonly known as ‘knit bone’. Modern research shows that comfrey contains two main active ingredients: allantoin which promotes tissue regeneration, and rosmarinic acid which damps down inflammation and reduces pain. Comfrey root cream is a popular and effective treatment for joint pain, sprains and strains.

A study involving 120 people with acute upper or lower back pain showed that rubbing in comfrey cream, three times a day for 4 to 6 days, reduced pain intensity by 95%, compared with just 38% reduction for inactive ‘placebo’ cream. Comfrey works quickly, providing good pain relief within an hour of application. In fact, researchers have found that comfrey cream is more effective than a prescribed, non-steroidal anti-inflammatory treatment (diclofenac gel) for treating ankle sprains.

Comfrey Ointment remains a popular treatment for a variety of muscle, joint and back aches and pains, because it works. Many original brands, developed by traditional medical herbalists are still going strong.

Capsicum pain relief cream

Capsicum is an extract from the chilli or cayenne pepper which reduces pain by continuously stimulating nerve endings in the skin at a very low-level. This depletes nerve endings of neurotransmitter chemicals so they become less sensitive and pass on fewer pain messages to the brain. Those messages that are passed on tend to get screened out as they brain shuts off distracting, low-level irritation. Ingredients that do this are known as ‘counterirritants’. These effects also reduce sensation from underlying painful joints. See the best capsicum containing rubs at Amazon.co.uk or Amazon.com . Warning! These are HOT to use, but really relieve muscle and joint pain. Wash your hands thoroughly after use and do them rub your eyes by mistake during use.

Green-lipped mussel pain relief gel

Green-lipped mussel extracts were first investigated as a pain-relieving ingredient when it was noticed that Maori living in coastal regions suffered less arthritis symptoms than those living inland. Those who regularly consumed these delicious, green-lipped mussels tended to remain free of joint problems.

Freeze-dried extracts of raw New Zealand green-lipped mussels are now known to contain unique omega-3 fatty acids which damp down inflammation in a similar way to non-steroidal anti-inflammatory drugs (NSAIDs) to reduce joint pain and swelling. The original and best green-lipped mussel pain relief product is Pernaton Gel .

Essential oils for pain relief

Menthol, Levomenthol, Eucalyptus, Camphor and Oil of Wintergreen are often added to topical joint treatments. These essential oils are absorbed into the skin and stimulate skin receptors to produce either a warm sensation or a cooling sensation as they numb the pain. They work by overwhelming nerve endings with these sensations so pain messages do not get passed on. This is known as a counter-irritant effect. Wintergreen is also a rich source of methyl salicylate, a natural anti-inflammatory painkiller related to aspirin. These essential oil creams and gels tend to have names such as Deep Heat or Deep Freeze to describe how they feel during use.

Voltarol pain gel

Non-steroidal anti-inflammatory drugs (NSAID) are such effective pain killers that ibuprofen gel was originally only available on prescription. They are now widely available for self purchase and much better for your health than taking the same non-steroidal anti-inflammatory painkillers by mouth. NSAID pain relieving gels do not cause the same level of side effects as the oral versions, such as indigestion and heartburn. You do need to follow the in-pack instructions, however, and take care not to apply too much. In some cases, overuse of ibuprofen gel can increase your blood pressure.

I’m often asked which is the strongest ibuprofen gel. If you’re looking for the best muscle pain relief, however, I recommend diclofenac gel rather than ibuprofen gel. Research shows that diclofenac gel (Voltarol) is stronger and more effective than even a strong ibuprofen gel. If you still prefer to use an ibuprofen gel, however, you can find them on Boots.com .

Topical diclofenac gel (Voltarol) is highly effective for treating muscle and joint aches and pains. In fact, a direct comparison of topical non-steroidal anti-inflammatory diclofenac gel with an oral equivalent did not show any difference in their ability to reduce pain and stiffness. Data from 34 studies, involving over 7,600 people, suggests that the topical NSAID, diclofenac, is the most effective form of non-steroidal anti-inflammatory painkiller for applying to the skin to treat muscle and joint pain.

Tips for using a muscle pain relief cream or pain relief gel

Using a rub-in pain relief cream or gel can reduce the need for oral pain medication, such as paracetamol or ibuprofen tablets.

Don’t apply topical pain relief creams or gels to broken skin or they may sting like fury.

If you have hand eczema, cuts or other hand problems, wear a latex glove when applying your pain relief muscle or joint cream or gel or ask a close friend or relative to apply it for you.

For best results, apply a topical joint cream or gel after a warm bath or shower, or after exercise when you are still glowing, as this helps the treatment sink in more quickly.

Allergic reactions are uncommon, but on first use only apply a small amount to a clean, healthy area of skin and gently rub in until absorbed. Wait a while to test how you respond to the ingredients before using more. If skin redness, irritation or itching occurs, wash off and seek medical advice.

Wash your hands immediately after applying the treatment.

Don’t touch or rub your eyes while you have topical cream on your hands.

Wearing a neoprene joint wrap after applying the treatment will keep the area warm and may boost its effectiveness (NB check product leaflet first in case the manufacturer does not advise this).

Follow the directions on the package as some products may need to be used at regular intervals, while others may be used as and when necessary.

Do not use any topical treatments if you are pregnant or breastfeeding, without seeking advice from a pharmacist or doctor.

Have you used any rub-in pain killing creams, ointments or gels and found them helpful? If so, what symptoms did they relieve? How long did they take to work for you?

Click here to read my review of LQ Liquid Health Joint Care.

Click here to read my review of the best non-prescription oral pain killers.

Click here to read my post on the 9 Best Supplements For Knee Pain.

Click here to read about methods of pain relief for tennis elbow.

Click here to read about the best relieving devices.

experthealthreviews.com

See also:  Moisture and Mold Problems: Preventing and Solving Them in Your Home
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