Over the counter antifungal creams are used in the treatment of various conditions including ringworm, nappy rash, athlete’s foot, thrush and other infections caused by yeast (Candida species), mould and other fungi (for example Trichophyton species). In this post, I will summarise the use and availability of over the counter antifungal creams in the UK.
Where to buy over the counter antifungal creams?
Antifungals creams can be bought over the counter from supermarkets or pharmacies (GSL: General Sale List medicines). Sale of some antifungal creams is restricted to a pharmacy with products not available for self-selection by the public (Pharmacy-only medicines / P medicines).
Antifungal creams are available as generic items; for example, many supermarkets and pharmacies sell their versions of clotrimazole cream. Some antifungal creams are sold as branded products; for example, a popular clotrimazole cream brand is Canesten cream.
What antifungal drugs can be purchased in the form of creams?
There is a wide variety of antifungal products in the UK. The following antifungal drugs can be found in over the counter antifungal creams:
Which antifungal creams do I need?
Two factors which need to be taken into consideration when deciding on treatment with antifungal cream are:
- Intended use: what fungal infection do you want to treat?
- Age of the patient
Most antifungal creams have the same licensed use, for example, the treatment of an athlete’s foot or sweat rashes. However, over the counter clotrimazole creams (1% and 2%) are the only products licensed for thrush treatment.
Antifungal creams may have age restrictions. Check product information leaflet or speak to the pharmacist if not sure about the suitability. Clotrimazole 1% cream and miconazole 2% antifungal cream have no age restrictions; therefore, they may be considered as first-line treatment, for example, in the management of nappy rash. In contrast, clotrimazole 2% cream has age restrictions in the treatment of thrush.
Combination creams containing an antifungal agent and hydrocortisone (steroid), such as Canesten hydrocortisone or Daktacort, should not be used in children under ten years of age. When prescribed, products containing hydrocortisone can be used by children under ten years of age.
Verbal recommendation by GP or any other healthcare professional is not sufficient to purchase antifungal creams containing hydrocortisone outside of its licensed age.
What is the best over the counter antifungal cream?
Cochrane reviewed information from all clinical trials, which looked at the effectiveness of antifungal creams. A great deal of evidence supports the efficacy of over the counter antifungal creams. Terbinafine was named as the most effective topical antifungal cream (Crawford et al, 2007). Terbinafine is available in the UK (brand: Lamisil) in the form of creams, gel and solution for the treatment of athlete’s foot and dhobie itch in adults and children over 16 years of age.
Over the counter antifungal creams
1. Clotrimazole 1% antifungal cream
Active ingredient: clotrimazole 1%.
Clotrimazole 1% antifungals cream brands
Over the counter, clotrimazole is available as generic clotrimazole cream or as branded Canesten, Canesten Dual Action, Canesten Athlete’s Foot. Also available as own labelled product from larger pharmacy chains or supermarkets, for example, Boots antifungal cream. Some pharmacies sell 1% clotrimazole cream as a thrush cream; however, usually, there is no difference between ‘thrush’ preparation of 1% cream and any other brand of 1% clotrimazole.
Where can you buy clotrimazole 1% antifungal cream?
Clotrimazole 1% cream is licensed as pharmacy-only medication and general sale item; for example, Canesten Athlete’s Foot, Canesten Dual Action can be purchased off the shelf in the supermarket.
Clotrimazole 1%: age restrictions
There are no specific age restrictions for clotrimazole 1% cream. Clotrimazole 1% cream is licensed for young children and the elderly.
How often and how long clotrimazole 1% antifungal cream needs to be used for?
Over the counter, clotrimazole antifungal cream is usually applied 2-3 times a day. Duration f the treatment depends on the type of infection treated; for example, clotrimazole cream should typically be used for at least two weeks to treat candida infections, like nappy rash.
2. Clotrimazole 2% antifungal cream
Over the counter clotrimazole antifungal cream is available as 2% preparation, which is double the strength as compared to 1% clotrimazole. Canesten 2% antifungal creams are sold under the brand name of Canesten Thrush External Cream.
2 % clotrimazole antifungal cream is licensed for the treatment of candidal vulvitis and candidal vaginitis (thrush). Canesten 2% Thrush cream can also be used by a sexual partner to prevent re-infection
Where can you buy clotrimazole 2% antifungal cream?
Canesten Thrush External Cream is a pharmacy-only medication that can be purchased from the pharmacy only, including online chemists.
Canesten 2% thrush cream: age restrictions
Patients aged under 16 or over 60 years should seek medical advice before using Canesten 2% thrush cream.
How often and how long Canesten 2% thrush cream needs to be used for?
The cream should be applied two to three times a day until patients are free of symptoms unless the cream is used alongside other treatments of the vaginitis. In this case, it is recommended to see a doctor if symptoms do not improve within seven days of the treatment.
3. Clotrimazole and hydrocortisone cream (Canesten Hydrocortisone)
It is possible to buy a combination cream containing an antifungal drug, clotrimazole, and hydrocortisone, which is a mild steroid. Canesten Hydrocortisone and Canesten Hydrocortisone Athlete’s Foot 1% are combination creams of 1% clotrimazole and 1% hydrocortisone.
Addition of mild steroid in the formulation help with fungal skin infections with other symptoms present.], such as inflammation, itching.
Canesten products containing both active ingredients are licensed for the treatment of:
- Athlete’s foot and
- Candidal intertrigo (fungal infection located in between folds of adjoining skin)
Canesten Hydrocortisone: age restrictions
Children under ten years of age should not be used over the counter Canesten Hydrocortisone unless prescribed by a doctor.
How often and how long can I use Canesten Hydrocortisone cream for?
Canesten Hydrocortisone is usually applied twice a day for a maximum period of 7 days. Hydrocortisone containing products should be applied thinly and evenly.
Other important information
There is a number of important information about the use of Canesten Hydrocortisone creams. For more information, please refer to the product information leaflet.
4. Miconazole containing antifungal creams
There are several antifungal creams containing miconazole. The table below summarises the availability of different brands of miconazole creams, including a combination cream of miconazole and hydrocortisone.
|Active drug||Brand name||Where to buy||Age restrictions|
|Miconazole 2%||Daktarin 2% Cream||Pharmacy-only product, not available for self-selection||No minimum age specified, but can be used in babies for example to treat nappy rash.|
|Miconazole 2%||Daktarin Aktiv Cream||Available for self-selection from supermarkets and pharmacies||For all ages.|
|Miconazole 2% and hydrocortisone 1%||Daktacort Hydrocortisone cream||Pharmacy-only product, not available for self-selection||Children 10 years of age and above|
Miconazole containing creams: licensed use
Daktarin Aktiv cream (GSL) is licensed for the treatment of athlete’s foot. In contrast, Daktarin 2% cream (P) is licensed for the management of fungal infections of skin and nails, and superinfections caused Gram-positive bacteria.
Miconazole antifungal creams: dosage and duration of the treatment
Daktarin is typically used twice daily with the recommended duration of treatment at least one week after symptoms are resolved. Check product information leaflet for more details, as the recommended dosage may vary between different treatments.
Similar to other antifungal creams containing hydrocortisone, Daktacort hydrocortisone is indicated in an athlete’s foot and candidal intertrigo (sweat rash / fungal infection located in between folds of adjoining skin) with symptoms of inflammation, such as redness. Daktacort is also licensed for skin infections associated with gram-positive bacteria, such as Streptococcus and Staphylococcus.
Daktacort hydrocortisone cream should be used for up to 7 days. It is possible to use Daktarin cream after Daktacort cream after symptoms of inflammation are resolved.
5. Over the counter ketoconazole cream
Ketoconazole is sold over the counter as branded products:
- Daktarin Intensiv Cream, available as general sale item for self-selection in pharmacies and supermarkets
- Daktarin Gold 2% cream, available as pharmacy-only medication, not available for self-selection
Both Daktarin Intensiv and Daktarin Gold creams contain the same amount of ketoconazole in the formulation: 2%.
Both creams are licensed in the treatment of an athlete’s foot and dhobie itch (tinea cruris). Daktarin Gold has an additional licensed indication of sweat rashes.
Ketoconazole cream: age restrictions
Daktarin Intensiv and Daktarin Gold creams are licensed for adults use only.
How often and how long should you use Daktarin creams (ketoconazole)?
Product information for both the above products recommends once or twice daily applications for 4-6 weeks. Patients should see a doctor if no improvement in symptoms is achieved in 4 weeks.
6. Over the counter antifungal cream: terbinafine
Terbinafine cream brands and availability
Terbinafine 1% cream is available as a general sale item in the following brands:
- Lamisil AT 1%
- Boots Athlete’s Foot 1%w/w Cream
- Scholl Advance Athlete’s Foot Cream
All the above brands of terbinafine cream are general sale items available for self-selection by patients from supermarkets and pharmacies.
Terbinafine cream: uses
Terbinafine antifungal cream is used for the treatment of:
- Athlete’s foot
- Dhobie itch
Terbinafine cream age restrictions
All brands of over the counter terbinafine antifungal cream are licensed for adults and children 16 years of age and over.
How often and how long to apply terbinafine cream
Terbinafine is usually applied once daily for one week.
Terbinafine is also available in the form of a solution, sold as Lamisil Once. Lamisil Once is licensed for the treatment of athlete’s foot in adults of 18 years of age and over.
In the treatment of athlete’s foot, Lamisil Once requires one application only.
Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot.. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001434. DOI: 10.1002/14651858.CD001434.pub2. Available at: https://doi.org/10.1002/14651858.CD001434.pub2 Accessed on 19/05/2020