Class: Imidazole Antifungal
Dosage Forms. Topical Cream: 2%, Topical Foam: 2%, Topical Gel: 2%, Topical Shampoo: 1% (OTC), 2% (by prescription)
Common FDA Label Indication, Dosing, and Titration.
1. Candidiasis of skin: Apply 2% cream topically once daily for 2 wk
2. Dandruff: Apply shampoo 1% topically to wet hair, lather, rinse thoroughly, and repeat; use every 3-4 d for up to 8 wk; then as needed to control dandruff
3. Pityriasis versicolor: Apply 2% shampoo topically to damp skin and a wide surrounding margin, lather, leave on skin for 5 min, then rinse, or apply 2% cream to affected areas once daily × 2 wk
4. Seborrheic dermatitis: cream, gel, foam: Apply topically to the affected area bid for 4 wk or until clinical clearing
5. Tinea corporis: Apply 2% cream topically once daily for 2 wk
6. Tinea cruris: Apply 2% cream topically once daily for 2 wk
7. Tinea pedis: Apply 2% cream topically once daily for 6 wk
Off-Label Uses. None
MOA. Ketoconazole inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.
Drug Characteristics: Ketoconazole Topical
Medication Safety Issues: Ketoconazole Topical
Drug Interactions: Ketoconazole Topical. None known with topical product; many interactions with oral formulation
Adverse Reactions: Ketoconazole Topical
Efficacy Monitoring Parameters. Resolution of erythema and pruritus. Improvement in erythema and pruritus usually occurs within 3-5 d. If no improvement is seen after 1 wk of treatment for tinea cruris or tinea corporis or after 2 wk of treatment for tinea pedis, then the diagnosis should be reviewed.
Toxicity Monitoring Parameters. Seek medical attention if severe skin irritation or rash.
Key Patient Counseling Points. Apply thin layer to affected area of skin. Skin should be intact. Do not get it in your eyes, nose, mouth, or vagina. Do not wash the areas where you applied this medicine for at least 3 h after application. Cosmetics (makeup or sunscreens) may be put on the affected areas 20 min after application. Topical products are alcohol based and flammable immediately after application.
Clinical Pearls. Topical products typically not effective in toenail onychomycosis. Resistant infections typically require oral therapy.