Blogger Divyanshu Verma‘s skin was itchy. He suspected his mild, but bothersome symptoms were caused by ringworm, so he found himself an over-the-counter (OTC) antifungal cream called “Ring Guard” which contains low concentrations of several antifungal medications. After using the cream for two weeks, he says, the infection disappeared. Unfortunately, his smooth skin didn’t last long, as shortly after stopping the cream application symptoms emerged again. This time, he tried a homeopathic remedy called Dr. Reckeweg R82 which contains a natural antimicrobial and several fungi that the company says help stimulate your immune response. It took longer—four months this time—to clear the infection, but he says it hasn’t come back since. It’s important to note that the evidence supporting this remedy is very limited on this supplement, and supplements and side effects of antifungal are not regulated by the Food and Drug Administration (FDA) and can be tainted with drugs or dangerous contaminants.
Here’s what you need to know about antifungal drugs, soaps, creams, and their side effects.
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What Are the Types of Fungal Infections?
There are many different types of fungi that can infect your skin, nails, lungs, eyes, and other bodily systems. Some of the most common infections are caused by “Candida albicans,” a species of fungus that lives in and on your body in small amounts all the time, but can start to grow out of control under certain circumstances, such as after you take antibiotics.
Other fungi, like “Candida auris,” are more commonly found in hospitals, where they can spread among patients with weakened immune systems. Lastly, some come from contact with animals, soils, or tropical environments.
Where Fungal Infections Occur
Fungal infections can occur throughout your body and even enter your bloodstream and brain, but the most common places to get them are the parts of your body that have contact with the outside world the most, including:
- Skin (athlete’s foot, jock itch, dandruff, ringworm)
- Nails
- Genitals (yeast infections)
- Mouth (oral thrush)
- Airways and lungs
Fungal Infection Treatment
People use a variety of strategies to get rid of fungal infections, depending on the location and severity of the infection. In some cases, you may be able to use foods, soaps, probiotics, or essential oils to treat mild fungal infections on your skin or nails, but in other cases, you’ll likely be prescribed an antifungal drug, which can come in cream, ointment, pill, or infusion form.
How Do Antifungals Work?
Antifungals are medications that work by killing fungus or stopping it from replicating and spreading. Note, much like bacteria, your body does need some fungi, and killing all of it can cause other problems, such as an increased risk of bacterial infections.
Antifungals
For some types of skin and nail infections, you may be able to purchase an OTC antifungal cream, ointment, or vaginal tablets. Still, it’s best to speak with your healthcare provider before taking an OTC antifungal if you can, because bacterial infections can cause similar symptoms. If you have a bacterial infection, and you take an antifungal, you might worsen the bacterial infection. Antifungal medications only kill fungus; for bacteria, you need an antibiotic. If the infection is more severe, you may need a prescription antifungal.
Azole Antifungals
This is the largest class of antifungal medications. There are many different types of azole antifungalsThey work by breaking holes in the fungal membrane, eventually causing the cells to die. You can recognize them if the generic name of the drug (not the brand name) ends in “-azole.” Azoles are found in OTC antifungal drugs, shampoos, eye drops, and creams, as well as various prescription medications.
Some examples of azoles include:
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
- Isavuconazole
- Ketoconazole
Side Effects of Azole Antifungals
Gastrointestinal side effects and liver damage are common with the azoles, but many other side effects are specific to each medication. They include the following.
Fluconazole
- Hair loss
- Chapped lips
Itraconazole
- Hypertension
- Low potassium which can cause fatigue, muscle cramps, and abnormal heart rhythms
- Swelling
- Heart failure
Voriconazole
- Vision changes
- Skin rashes after sun exposure
- Hair loss
- Inflammation of the tissue that surrounds bones, causing pain
Posaconazole
- Reduced hormone synthesis that causes fatigue, muscle loss, and appetite loss
- Kidney dysfunction
Isavuconazole
- Liver damage
- Low potassium levels that can cause fatigue, muscle cramps, and abnormal heart rhythms
- Swelling
- Heart rhythm changes
Ketoconazole
- Severe liver damage
- Reduced hormone synthesis that causes fatigue, muscle loss, and appetite loss
- Dizziness
- Hair loss
- Itching
Terbinafine
Terbinafine is an antifungal that is often used to treat fungal infections in your nails. It works by causing a buildup of a poisonous molecule in the fungal cell that eventually kills the cell.
Side Effects of Terbinafine Antifungals
The most common side effects of terbinafine antifungals are:
- Headaches
- Gastrointestinal symptoms (diarrhea, vomiting, upset stomach)
- Rash
Rarer side effects that also typically go away quickly include:
- Visual disturbances
- Foul or metallic taste in the mouth
- Elevated liver enzymes, signifying damage to the liver
Gris-PEG (griseofulvin)
Griseofulvin is often used to treat ringworm infections on your scalp. It stops the fungus from growing and spreading.
Side Effects of Griseofulvin Antifungals
The most common side effects of griseofulvin antifungals are:
- Gastrointestinal issues such as nausea, vomiting and diarrhea
- Headaches
- Allergic reactions
In rarer cases, people also experience:
- Sensitivity to light
- Rashes and hives
- Discolored patches of skin
- Worsening of lupus
Griseofulvin interacts with many other medications, such as warfarin, a blood thinner. It can also make you sick if you drink alcohol while taking it. Be sure to review all of your medications, supplements and even alcohol consumption with your healthcare provider before taking griseofulvin.
Lastly, you should avoid griseofulvin if you are pregnant. It caused birth defects in animal studies.
Amphotericin B
Amphotericin B is an antifungal that you usually get in the hospital in an intravenous infusion, to treat severe fungal infections that have reached your organs, bloodstream or brain. It kills fungal cells by opening holes in the cell membrane that let ions like potassium to flow out of the cell.
Side Effects of Amphotericin B
Kidney problems are very common. They affect nearly 80% of people who receive amphotericin B. Your healthcare provider will need to monitor your kidney function throughout your treatment.
The most common side effects of amphotericin B include:
- Loss of potassium that can cause fatigue, muscle cramps, and abnormal heart rhythms
- Loss of magnesium that can cause tremors, muscle weakness, spasms, and abnormal eye movements
- Allergic reactions
- Fevers
Long term use of amphotericin B can cause anemia.
Mycostatin (Nystatin)
Nystatin is available in several forms, including a mouthwash, cream, and tablet to treat oral thrush and fungal skin infections. It works by poking holes in the fungal cell membrane so ions and other contents pour out.
Side Effects of Nystatin
Common side effects of nystatin include:
- Gastrointestinal distress such as diarrhea, nausea and vomiting
- Rashes and hives
Rarely, you may experience
- A high heart rate
- Coughing and wheezing
- Facial swelling
- Muscle pains
Tolnaftate
Tolnaftate is a topical antifungal that comes in many forms including sprays, creams and powders. It is often used for fungal infections on your nails, feet or genitals.
Side effects of Tolnaftate include:
- Skin irritation
- Allergic reactions that cause hives, swelling, and difficulty breathing
Natamycin
Natamycin is an eye drop that can treat fungal infections in the outer areas of the eye. Few side effects of natamycin have been reported aside from eye irritation and potential allergic reactions.
Flucytosine
This drug is typically used in combination with amphotericin B to treat severe fungal infections. It interferes with fungal DNA, killing the fungus or preventing it from spreading.
Flucytosine can cause serious side effects including:
- Leukopenia, low white blood cells, which can make it difficult to fight infections
- Thrombocytopenia, a low number of platelets in the blood that can lead to dangerous bleeding
- Liver damage
Echinocandins
Echinocandins are typically used to treat severe fungal infections. They work by weakening the fungal cell wall.
Side Effects of Echinocandins
- Liver damage
- Injection site pain
- Kidney damage
On rare occasions, patients have reported:
- Anemia
- Leukopenia or neutropenia, low white blood cells, which can make it difficult to fight infections
- Thrombocytopenia, a low number of platelets in the blood that can lead to dangerous bleeding
Animal studies have suggested that the drug could raise the risk of birth defects if you’re pregnant when you take it.
Tavaborole, Ciclopirox, and Butenafine
These are all topical treatments for toenail fungus, and they come with similar side effects.
Side Effects of Tavaborole, Ciclopirox, and Butenafine
- Ingrown toenails
- Skin irritation
Treatments for Vaginal Yeast Infections
Vaginal yeast infections respond to over-the-counter antifungals, such as Monistat, but these drugs can make your vaginal infection worse if a doctor hasn’t confirmed that fungus is truly the cause of symptoms.
“If it is a yeast infection, well, [OTC antifungals] do help, but in the majority of cases it’s not [actually a yeast infection]. And then what happens is they kill off the good organisms, and then you set yourself up for recurrent infections,” says Michael Tahery, MD, a urogynecologist in Los Angeles. OTC antifungals are typically “azoles.”
Using an antifungal medication may reduce the likelihood of having another vaginal yeast infection in the next six to 12 months, according to a Cochrane Review of 23 studies. However, the authors of the review note that many studies in the review were funded by industry sponsors, and thus the results may be biased toward medication.
Adding a probiotic may also help reduce the likelihood of a yeast infection coming back after you’ve treated it. If you don’t want to take supplements, you can eat foods like yogurt, kimchi, kombucha, sauerkraut, or kefir, which also contain probiotics.
These topical antifungals come with similar side effects including:
- Itchiness and pain
- White, yellow, or greenish discharge
- Painful or difficult urination
Antifungals for Skin Infections
Some antifungals are made only for skin infections, others are used for both vaginal infections and fungal infections on the skin. Different topical antifungals seem to work equally well for most skin infections, according to a 2014 review of 129 studies.
Symptoms such as reddened skin may fade faster if the antifungal is combined with a corticosteroid. But, of course, adding a corticosteroid raises your risk of side effects.
For athlete’s foot, the infamous locker room-dwelling fungal infection on the skin of the foot, a review of 15 trials found that terbinafine and itraconazole were the most effective treatments that you take by mouth.
Antifungals for Nail Infections
Azoles and terbinafine seem to work equally well for clearing fungal nail infections. Griseofulvin also worked well, but was more likely to cause side effects, such as nausea, than the other two, according to a 2017 review of 48 studies. If the infection is mild, Robert Stabile, a podiatrist based in East Meadow, New York, told MedShadow for a previous article on toenail fungus that he would try other remedies before resorting to medication.
“I will have my patients soak their toenails in white vinegar or fungal shampoo preparations in addition to having them file down the affected toenail,” he says, before turning to antifungal medications.
Natural Antifungals for Skin Infections:
If your infection is mild, you might consider reaching for a natural remedy before reaching for the antifungal drugs. In addition to white vinegar, some options might include:
- Tea tree oil: you can apply a few drops to the infected area. Be sure to do a spot test on a healthy area of skin to make sure that the oil won’t irritate your skin. It’s also a good idea to dilute the essential oil in some coconut oil or add it to bathwater.
- Honey: applying some types of honey to your skin may also help suffocate fungal infections.
Antifungal Shampoo and Antifungal Soap
If your fungal infection is causing dandruff on your scalp, there are antifungal shampoos available OTC and by prescription. Some (such as Selsun Blue) contain selenium sulfide, which stops the fungus from replicating, others contain antifungal medications such as ciclopirox or ketoconazole.
Experts recommend using the shampoo twice a week. If someone else in your home has a fungal infection of the scalp, it can be helpful for you to also use the shampoo to lower the risk of it spreading. There are soaps with the same ingredients available OTC to help prevent the spread or return of fungal infections on the rest of your body.
Antifungals for Oral Thrush
Oral thrush is a fungal infection of your tongue and the surfaces of your mouth. It may make your tongue look yellow or white. You may be able to find OTC antifungal mouthwash, but if the infection persists, you should see your healthcare provider for a prescription, because if it goes untreated, it could spread to your esophagus and become more serious. You may be able to use tablets that dissolve in your mouth or a type of mouthwash that you swish and swallow if the infection is still mild. However, if the infection has spread, you may need to swallow pills.
Natural Treatments for Oral Thrush
If your oral thrush is only small patches in your mouth, there are some natural home remedies you can try, but be sure to talk to your health care provider if your symptoms persist. The evidence for these techniques is very limited.
- Baking soda: small studies in humans and petri dishes suggest that swishing with a small amount of baking soda (¼ teaspoon) dissolved in a cup of water
- Apple cider vinegar: a small amount of of apple cider vinegar (less than a teaspoon) diluted water may help kill fungus.
- Probiotics: taking probiotics may help restore balance to the microbes in your mouth, and control the infection.
Antifungals for Fungal Ear Infections
If you have a fungal infection in your ear, you should see your health care provider for a thorough cleaning. Then, he or she will likely recommend a topical antifungal treatment if the infection is only in the skin of the outer ear canal.
How to Get Rid of Fungal Acne
Both bacteria and fungi can cause acne. In some cases, both may be behind your breakouts. Fungal acne is more common in areas that are hot and humid and in people whose immune systems are weakened due to preexisting conditions or medications. Your dermatologist may prescribe topical antifungals that include azoles or terbinafine. In some cases, he or she may recommend that you swallow antifungal pills.
Antifungals for Infections in the Blood, Brain, and Body
If the fungal infection, such as invasive candidiasis, reaches your bloodstream, organs or brain, you’ll probably be in the hospital receiving intravenous antifungal treatments. These infections are very serious and can be fatal if not treated. They’re most common in people whose immune systems are not functioning well due to a condition like HIV, immunosuppressant drugs after a transplant, or cancer treatments.
How Do You Get a Fungal Infection?
Some fungal infections are contagious, like ringworm, athlete’s foot, and some hospital-acquired infections.You can get these infections from touching the same surfaces as another person or animal who’s infected, or even by breathing the same air.
Other types of fungal infections, like vaginal yeast infections or oral thrush, can be passed from person-to-person, or they can be caused by an overgrowth of a fungus that’s always in your body in small amounts. Your body is full of healthy bacteria, viruses and fungi, but sometimes the fungus can grow out of control causing symptoms like redness and itchiness. Some fungal infections are side effects of taking antibiotics, for example, because antibiotics kill the good bacteria that can help balance the population of fungus.
What Does a Fungal Infection Look Like?
Fungal infections may look different depending on where they are on your body and the type of fungus causing them. On the skin, fungal infections can cause redness, peeling, and discoloration of the skin. If the infection is caused by ringworm, it may start to form a raised ring. In the mouth, a fungal infection may cause white patches on your tongue cheeks. In any location, the infection may itch or burn.
How Can You Tell if a Rash is Fungal or Bacterial?
Unfortunately, fungal and bacterial infections are very similar. It’s best to have a healthcare provider help you determine the cause of your symptoms and decide whether you should use antifungal or antibacterial treatments. It’s important to know that using the wrong one could worsen your symptoms.
HIV and Fungal Infections
Having HIV raises your risk for fungal infections because the disease weakens your immune system’s ability to fight them off. If you have HIV, and your CD4 counts (the amount of a particular type of immune cell) are low, regularly taking an antifungal medicine can lower your risk of developing cryptococcal disease, a dangerous fungal infection that can attack the lungs and brain, by 71%, according to a 2018 review of nine clinical trials.
If you take prophylactic antifungals, you may have a higher risk of developing vaginal yeast infections that are resistant to fluconazole, but other antifungal treatments are available.
Cancer and Fungal Infections
Cancer treatments such as chemotherapy and bone marrow transplants can also weaken your immune system by lowering the number of certain immune cells in your body and thus raise your risk of developing a fungal infection. If these infections spread through your body, they can be fatal. That’s why many doctors prescribe antifungal drugs to people undergoing cancer treatment in hopes of preventing infections, or as soon as they have a fever.
A 2014 review of 34 clinical trials found that intravenous amphotericin B and fluconazole could reduce the number of deaths due to fungal infections in cancer patients. Three of the drugs, amphotericin B, fluconazole and itraconazole, reduced fungal infections. Ketoconazole or miconazole were less effective for cancer patients.
Autoimmune Disease and Fungal Infections
The drugs you’re prescribed for autoimmune infections, such as corticosteroids or methotrexate, often weaken your immune system, and may make you more susceptible to all types of infections, including fungal infections, so you should be sure to contact your healthcare provider at the first sign of any infections.
Fungal infections can range from a very mild annoyance to a severe disease. Even if your condition seems mild, if it doesn’t go away after a few weeks of natural or OTC remedies, be sure to contact your healthcare provider to ensure you’re using the right treatment.
