Since thrush (candidiasis) is a consequence of exposure to a specific fungal infection, any means against the symptoms of the disease (rash, redness, itching, maceration, discharge) are not suitable. An effective ointment for thrush is needed, that is, etiotropic treatment with the help of external agents acting directly on the causative agent of the disease – the yeast-like saprophytic fungus Candida albicans.
Indications for use of ointments from thrush
The main indications for the use of ointments for thrush are: candidiasis of various localization in case of damage to the skin and mucous membranes of C. albicans (the fungus C. tropicalis, C. glabrata, C. parapsilosis and C. krusei are much less often the cause of pathology), including thrush or urogenital candidosis – candidal vulvovaginitis, balanitis, balanoposthitis. Such external agents are also used in cases of candidiotic lesions of the perianal area, axillae, nail plates and skin of the periungual ridge (onychomycosis).
Some ointments used for thrush are also used for other types of fungal diseases, in particular, provoked by yeast-like fungi Rhodoturola mucilaginosa, Rhodotorula glutinis, Malassezia furfur, Torulopsis glabrata, as well as Aspergillus and Dermatophytosis Microsporum, Trichothytontonbrabrata, as well as Aspergillus and Microsporum dermatophytosis, Trichotonton chirabrata, as well as dermatophytes, Microsporum glacine, and Aspergillus.
It should be noted that the ointment from thrush for women has no differences according to the patient’s “gender”, and the ointment from thrush in men is absolutely no different. So compulsory simultaneous treatment of urogenital candidiasis in both partners (she has a vulvovaginal candidiasis, he has balanitis) is carried out with the same drugs.
In the list of the most effective antifungal drugs prescribed by gynecologists and dermatologists, you can include such names of ointments from thrush as:
- Clotrimazole ointment, as well as other trade names of ointments with the same active substance: Candide ointment, Kanesten, Canizon, Agisten, Lotrimin, Yenamazol, Antifungol, Oronazol;
- nystatin ointment;
- Pimafucin ointment;
- Pimafukort ointment;
- Levorin ointment;
- Lomexin Cream;
- Miconazole ointment (Dactar, Dactarin, Mikozon, Surolan, etc.);
- Zalain (cream);
- Triderm ointment.
But to ointments that are not used in the treatment of thrush, include:
- Acridem ointment (contains betamethasone corticosteroid and gentamicin antibiotic, not acting on C. albicans);
- Acyclovir ointment (intended for the treatment of skin lesions with a herpevirus);
- Methyluracil ointment (used for radiation injuries of the skin, poorly healing burns, wounds and ulcerations);
- tetracycline ointment (used for infectious lesions of the skin and subcutaneous tissue, accompanied by suppuration);
- synthomycin ointment and its synonym – Levomekol ointment (contains the antibiotic chloramphenicol and is used in the treatment of pustular lesions and purulent-necrotic inflammation of the skin, wounds, cracks, burns and ulcers);
- streptocidal ointment (used for abscesses of the skin and subcutaneous tissue, boils, cellulitis, erysipelas, burns and wounds);
- calendula ointment (helps with minor skin lesions);
- zinc ointment (antiseptic, anti-inflammatory and anti-exudative, but does not affect the fungus Candida albicans);
- oxolinic ointment (used for viral inflammation of the nasal mucosa, as well as for vesicular and scaly deprive).
Clotrimazole ointment (ointment Candid, Kanesten et al. Synonyms) comprises an imidazole derivative clotrimazole, which inactivate peroxidase mitochondrial enzymes in Candida cells reduces the biosynthesis of sterols needed to form a shell glikoproteinadgezina fungal cells which multiplies not spores, and budding. As a result of the lack of sterols, the plasma membranes of the cells of the fungus lose their impenetrability and, together with it, the ability to multiply and exist.
The drug Lomeksin in the form of a vaginal cream acts in the same way, but already at the expense of another imidazole derivative, fenticonazole, in the ointment Zalain the antimycotic sertaconazole is the active antifungal substance, and the pharmacodynamics of the ointment from thrush Miconazole is based on the action of miconazole nitrate.
Thanks to nystatin (the antibiotic-polyene mycozaminilinatatinolide), nystatin ointment also acts on the cell wall 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 process of oxygen consumption by the fungus cells. All this together provokes coagulation of cytoplasmic proteins, leading to the lysis of C. albicans cells.
Antifungal effect similar to nystatin, has an ointment for thrush Levorin (with heptaene aromatic antibiotic levorin).
Pimafucin ointment contains polyene natamycin, the pharmacodynamics of which is similar to clotrimazole. Ointment Pimafukort, except for natamycin, has in its composition active against many bacteria the antibiotic neomycin and hydrocortisone, which relieves inflammation and itching of the skin in thrush.
The composition of the ointment Triderm included corticosteroid betamethasone, antibiotic gentamicin and clotrimazole. The action of clotrimazole has been described above; gentamicin prevents bacterial infection, and corticosteroid helps relieve inflammation and itching.
And although all of these tools reduce the onset of symptoms of candidiasis, due to corticosteroids in the composition of Pimafukort and Triderm both the one and the other itch ointment for thrush is most effective.
When applied to the mucous membranes with vaginal candidiasis (thrush), absorption of clotrimazole, which contains Clotrimazole ointment, Candide ointment and Triderm ointment, does not exceed 5-10%, and its concentration in the vaginal mucus (with intravaginal administration) is much higher than in plasma blood, and lasts for 2-3 days. Clotrimazole is transformed in the liver and excreted through the intestines.
Nystatin ointment through the mucous membranes is not absorbed and poorly penetrates intact skin, so the systemic adsorption of the drug is not marked.
In the absence of damage to the skin and mucous membranes, Pimafukort ointment is also poorly absorbed; hydrocortisone adsorption ranges from 1 to 5%. Data on the biotransformation of the components of the ointment in the instructions there.
In the description of the pharmacokinetics of the drug Lomeksin indicated that fenticonazole is practically not absorbed and its content is not detected in the blood.
Instructions for ointments Pimafutsin, Levorin and Triderm do not contain information regarding adsorption, systemic metabolism and excretion of these drugs.