Ointments from thrush
Since thrush (candidiasis) is a consequence of the effects of a particular fungal infection, then any remedy against the symptoms of the disease (rash, redness, itching, maceration, discharge) are not suitable. An effective ointment from the thrush is needed, that is, etiotropic treatment with the help of external agents acting directly on the causative agent of the yeast-like fungus-saprophyte Candida albicans.
Indications of the ointments from thrush
The main indications for the use of ointments from thrush: Candidamycosis of various locations in the lesions of the skin and mucous membranes of C. Albicans (much less the cause of the pathology are fungi C. Tropicalis, C. Glabrata, C. Parapsilosis and C. Krusei), including thrush or urogenital candidiasis - candidiasis vulvovaginitis, balanitis, balanoposthitis. Such external means are also used in cases of candidamycotic lesions of the perianal region, axillary hollows, nail plates and skin of the peri-osedocular roller (onychomycosis).
Some ointments used for thrush are also used in other types of fungal diseases, in particular, caused by yeast-like fungi Rhodoturola mucilaginosa, Rhodotorula glutinis, Malassezia furfur, Torulopsis glabrata, and Aspergillus and dermatophytes Microsporum, Trichophyton, Epidermophyton.
It should be noted that the ointment from the thrush for women does not differ by the "sex" of the patient, and the ointment from the thrush in men is absolutely no different. So the compulsory simultaneous treatment of urogenital candidiasis in both partners (she - candidiasis vulvovaginitis, he - balanitis) is carried out by the same drugs.
In the list of the most effective antifungal agents appointed by gynecologists and dermatologists, you can include such names of ointments from thrush, such as:
- ointment Clotrimazole, as well as other trade names of ointments with the same active substance: Candide ointment, Kanesten, Kanison, Agisten, Lotrimin, Yenamazol, Antifungol, Oronazol;
- nystatin ointment;
- ointment Pimafucin;
- Pimafukort ointment;
- ointment Leworin;
- Lomexin cream;
- Miconazole ointment (Daktar, Daktarin, Mikozon, Surolan and others);
- Zalain (cream);
- ointment Triderm.
But the ointments that are not used in the treatment of thrush include:
- Acriderm ointment (contains corticosteroid betamethasone and antibiotic gentamycin, not acting on C. Albicans);
- ointment Acyclovir (designed to treat lesions of the skin with herpesvirus);
- Methyluracil ointment (used for radiation injuries of the skin, poorly healing burns, wounds and ulceration);
- tetracycline ointment (used for infectious lesions of the skin and subcutaneous tissue, accompanied by suppuration);
- sintomycin ointment and its synonym - Levomekol ointment (contains chloramphenicol antibiotic and is used in the treatment of pustular lesions and purulent-necrotic skin inflammations, wounds, cracks, burns and ulcers);
- streptotsidovaya ointment (used for abscesses of the skin and subcutaneous tissue, boils, phlegmon, erysipelas, burns and wounds);
- ointment of calendula (helps with minor skin damage);
- zinc ointment (antiseptic, anti-inflammatory and anti-exudative, but does not work on Candida albicans);
- oxolin ointment (used for viral inflammation of the nasal mucosa, as well as for bladder and squamous lishy).
Clotrimazole ointment (Candide ointment, Kanesten and other synonyms) contains an imidazole derivative clotrimazole that inactivates mitochondrial peroxidase enzymes in candidate cells, reduces the biosynthesis of sterols necessary for the formation of the glycoproteinadegine membrane of the fungal cells, which multiplies not by spores but by budding. As a result of a lack of sterols, the plasma membranes of the fungal cells lose their impermeability, and together in it the ability to multiply and exist.
The drug Lomexin in the form of a vaginal cream acts in the same way, but already due to another imidazole derivative - fenticonazole, in zalain ointment an active antifungal agent is the antimycotic sertaconazole, and the pharmacodynamics of the ointment from the thrush Miconazole is based on the action of miconazole nitrate.
Thanks to nystatin (antibiotic-polyene mycosaminilistinistanolide), Nystatin ointment also acts on the cell membrane of the fungi, and, integrating into it at the molecular level, irreversibly increases the intracellular osmotic concentration of electrolytes, lowers the pH level and disrupts the oxygen consumption by the cells of the fungus. All this in aggregate provokes coagulation of cytoplasmic proteins, leading to lysis of C. Albicans cells.
An antifungal action similar to nystatin is provided by ointment from thrush Levorin (with a heptaenic aromatic antibiotic levorin).
Ointment Pimafucin contains polyene natamycin, the pharmacodynamics of which is similar to clotrimazole. Ointment Pimafukort, in addition to natamycin, has in its active against many bacteria antibiotic neomycin and hydrocortisone, which removes inflammation and itching of the skin with thrush.
The Tridentum ointment includes corticosteroid betamethasone, antibiotic gentamicin and clotrimazole. The action of clotrimazole has been described above; gentamycin prevents the attachment of a bacterial infection, and a corticosteroid helps to relieve inflammation and itching.
And although all of these remedies reduce the appearance of symptoms of candidiasis, due to corticosteroids in the composition of Pimafukort and Triderm, both of the itching from itching with thrush is most effective.
When applied to the mucous membranes with vaginal candidiasis (thrush), the absorption of clotrimazole, which contains the ointment Clotrimazole, Candida ointment and Triderm ointment, does not exceed 5-10%, and its concentration in the vaginal mucus (with intravaginal application) is much higher than in plasma blood, and persists for 2-3 days. Clotrimazole is transformed in the liver and is excreted through the intestine.
Nystatin ointment through the mucous membranes is not absorbed and poorly penetrates through intact skin, so the system adsorption of the drug is not noted.
In the absence of damage to the skin and mucous membranes, the Pimafukort ointment is also poorly absorbed; adsorption of hydrocortisone ranges from 1 to 5%. There are no data on biotransformation of ointment components in the instructions.
In the description of the pharmacokinetics of Lomexin, it is indicated that fenticonazole is practically not absorbed and its content is not detected in the blood.
Instructions for ointments Pimafucine, Levorin and Triderm do not contain information on adsorption, systemic metabolism and excretion of these drugs.
Use of the ointments from thrush during pregnancy
Use of ointments from thrush Pimafukort, Miconazole, Levorin, Zalain and Triderm are not recommended to pregnant and lactating women; ointment Clotrimazole should not be used in the first three months of pregnancy.
It is permissible to use Pimafucin ointment in the treatment of thrush in pregnant women, and nystatin ointment and Lomexin may be prescribed during pregnancy only on condition that the expected benefit for the mother will exceed the potential risk for the fetus.
Ointments from thrush have the following contraindications for use:
- ointment Clotrimazole (Candida ointment, etc.), Pimafucin, Lomexin, Zalain should not be used if hypersensitivity to the components of these drugs.
- inexpensive ointment from the thrush - nystatin and miconazole - is also not used in case of individual intolerance, which is manifested by dermatological allergic reactions.
- ointment Pimafukort and Ointment Triderm (because of the hydrocortisone content) are contraindicated in case of increased reaction of the organism to exogenous steroids and are not used in skin forms of venereal diseases, propensity to acne, ulceration and other open lesions of the skin and mucous membranes.
- ointment Leworin contraindication in the presence of anamnesis of any manifestations of allergy.
Side effects of the ointments from thrush
Almost any ointment from the thrush, in the first place, can cause local irritation, flushing and swelling of the skin and mucous membrane. This is characteristic of such drugs as ointment Clotrimazole (Candida ointment), ointments Pimafucin and Mikazol, ointments Levorin, Lomexin. A drug Zalain is capable of provoking erythema and temporary contact dermatitis.
Intravaginal application of ointments containing imidazole derivatives may be accompanied by burning, itching, increased discharge, and swelling of soft tissues and mucous membranes. Do not exclude the appearance of head and stomach pain, discomfort during urination and their frequency.
Prolonged use of the Pimafucort or Triderm ointment can lead to the formation of a strip-like atrophy of the skin (striae) at the site of application, clarification of the skin pigment at the site of application of the preparation, and the expansion of cutaneous capillaries in the form of a vascular network.
Dosing and administration
Any ointment from thrush should be applied to the affected area with a thin layer twice within a day. When applying the ointment is recommended to capture 5-10 mm of the surface of intact skin surrounding the area of damage.
Ointment Clotrimazole (Candide ointment, etc.) is used for about a month; nystatin ointment is used for a maximum of 10 days; Pimafucin ointment is applied within 15-20 days. Women Limexin and Pimafucin ointments should be injected deep into the vagina 1-2 times a day (morning and evening), and men - applied to the genital area and anus. Ointment is used until the symptoms of thrush disappear completely, and for about a week - as an ointment for the prevention of thrush.
Apply Pimafukort ointment twice a day for 14-28 days, 4-part application is allowed per day (with acute forms of candidiasis or dermatoses), adults can apply a bandage.
Miconazole ointment is recommended after applying slightly to rub into the affected area; the course of treatment for this drug is an average of 4 weeks.
Interactions with other drugs
Applying the ointment Clotrimazole (Candida ointment), you can not use other external antimycotics with polyene antibiotics (nystatin ointment, Pimafucin), as the therapeutic effect of the drugs decreases.
Data on drug interactions of other ointments from thrush indicated in the review are not given in the instructions.