Dermatophytoses and Cutaneous Candidiasis
Naftifine hydrochloride 1% topical cream or gel is used topically for the treatment of certain dermatophytoses (i.e., tinea cruris, tinea corporis, tinea pedis, and tinea manuum) caused by Trichophyton mentagrophytes,T. rubrum, T. verrucosum,T. violaceum,Epidermophyton floccosum, or Microsporum canis. Naftifine topical gel has been used with some success in the treatment of tinea unguium (onychomycosis). The drug also has been effective when used topically for the treatment of cutaneous candidiasis.
Tinea corporis and tinea cruris generally can be effectively treated using a topical antifungal; however, an oral antifungal may be necessary if the disease is extensive, dermatophyte folliculitis is present, the infection is chronic or does not respond to topical therapy, or the patient is immunocompromised because of coexisting disease or concomitant therapy. Many clinicians consider topical imidazole-derivative azole antifungals (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole) or topical allylamine antifungals (e.g., naftifine, terbinafine) the drugs of first choice for the topical treatment of tinea corporis or tinea cruris, although other antifungals agents (e.g., ciclopirox olamine, butenafine hydrochloride, tolnafate, undecylenic acid) also can be effective in the treatment of these infections. Uncomplicated interdigital and vesiculobullous forms of tinea pedis generally can be treated effectively using topical therapy with an imidazole-derivative azole antifungal (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole), an allylamine antifungal (e.g., naftifine, terbinafine), or other topical antifungal agents such as ciclopirox olamine, butenafine hydrochloride, tolnaftate, or undecylenic acid. However, an oral antifungal regimen usually is necessary for the treatment of hyperkeratotic areas on the palms and soles, for chronic moccasin-type (dry-type) tinea pedis, and for the treatment of tinea unguium (onychomycosis).
Results of controlled studies indicate that naftifine hydrochloride 1% cream is equivalent in efficacy and safety to topical clotrimazole 1% cream, miconazole nitrate 1% cream, econazole nitrate 1% cream, or tolnaftate for the treatment of dermatophytoses. In clinical studies, 2-4 weeks of therapy with topical naftifine hydrochloride 1% cream resulted in a clinical and mycologic cure in 78-100% of patients with tinea cruris or tinea corporis and 4-5 weeks of therapy resulted in a clinical and mycologic cure in 69-82% of patients with tinea pedis. Like imidazole-derivative azole antifungal agents (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole) and ciclopirox olamine, naftifine has an advantage over some other topical antifungal agents (e.g., nystatin, tolnaftate) in the treatment of mixed infections or for empiric treatment pending identification of the causative organism since the drug is active against both dermatophytes and Candida. However, in vitro on a weight basis, naftifine is considerably less active than imidazole derivatives against Candida.