Is there a non-prescription ketoconazole cream?

Table of Content:
What is ketoconazole cream and what is it used for? | Brands | Do you need a prescription? | Can I get an oral medication? | FAQ

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What is ketoconazole cream and what is it used for?

Ketoconazole cream (sold under the brand Nizoral cream) is a topical azole antifungal medication used in the treatment of yeast infections on the skin and it is often prescribed when over-the-counter treatments are ineffective. It works by inhibiting the production of ergosterol, a key component of fungal cell membranes, which leads to the death of the fungi or yeast causing the infection¹. 

Although ketoconazole cream is often prescribed to treat a wide variety of fungal infections, according to Dr. Carolina Fernandez, board-certified dermatologist, ketoconazole is most effective in the treatment of yeast infections and tinea versicolor (which is also caused by yeast). 

According to Dr. Fernandez, ketoconazole cream is less effective in the treatment of dermatophyte  skin fungal infections (ringworm).

What are the different brands of ketoconazole cream?

• Nizoral: A widely recognized brand for ketoconazole formulations, including creams and shampoos.
• Kuric: Another brand offering ketoconazole cream for topical antifungal treatment.
• Extina: This brand provides ketoconazole in a foam formulation, primarily used for seborrheic dermatitis.
• Xolegel: A brand that offers ketoconazole in a gel form for topical application².

These brands provide ketoconazole in different formulations to address various fungal skin conditions. Consult a board-certified dermatologist to determine the most appropriate treatment for your condition.

Is ketoconazole (Nizoral) cream non-prescription?

No, in the United States, ketoconazole (Nizoral) cream 2% requires a prescription. However, there are some ketoconazole shampoos with a low concentration (typically 1%), which are available over-the-counter.

How to get a prescription for ketoconazole (Nizoral) cream?

To get a prescription for ketoconazole (Nizoral) cream, you can have a telemedicine consultation via the Miiskin platform. All you need to do is describe your symptoms and share images of the affected area. A board-certified dermatologist will evaluate whether ketoconazole is the right treatment for your condition. If so, they will prescribe the medication, which you can then fill at a pharmacy or request from an online prescription service that delivers medications to your home.

Where can you buy ketoconazole (Nizoral) cream online?

Once your dermatologist writes you a prescription, you can buy your ketoconazole (Nizoral) cream at any local or online pharmacy. 

Can I get an oral anti-fungal medication for my condition via Miiskin?

Yes, oral antifungal medications are an option for certain fungal infections, especially when the infection is severe, widespread, or resistant to topical treatments. Oral antifungals like fluconazole, itraconazole, or terbinafine are commonly prescribed for conditions such as extensive athlete’s foot, onychomycosis (fungal nail infections), or deep fungal infections that affect the body more systemically. These medications work internally, targeting the fungus from within and providing a more comprehensive approach compared to topical treatments alone. However, oral antifungals may have some side effects or drug interactions, so they are typically reserved for cases where topical treatments are insufficient.  

Frequently asked questions about ketoconazole (Nizoral) cream

Is ketoconazole (Nizoral) cream 2% a steroid?

Dr. Fernandez says that ketoconazole (Nizoral) cream 2% is not a steroid. It is a topical antifungal medication that belongs to the azole class of drugs. Its primary function is to treat yeast infections by disrupting the fungal cell membrane. While ketoconazole cream is effective for conditions like seborrheic dermatitis, it does not have anti-inflammatory properties like corticosteroids. However, some combination creams (such as clotrimazole and betamethasone dipropionate cream) may include both an anti-fungal and a steroid, so it’s important to check the ingredients of the product you are using.

Dr. Fernandez says that as a general rule you should avoid using a combination cream consisting of a corticosteroid and an anti-fungal agent as these combined medications should only be administered when there is, for example, fungal eczema or other particularities that will be assessed by the doctor. However, they are generally administered when the doctor is not sure if they are treating a fungal infection or an inflammatory condition such as eczema or dermatitis.

What fungus does ketoconazole (Nizoral) treat?

Dr. Fernandez says that ketoconazole (Nizoral) is primarily effective against yeast infections and certain fungal conditions. It works well for infections caused by Candida species, such as cutaneous candidiasis, and for seborrheic dermatitis or pityriasis versicolor, which are associated with the yeast Malassezia. 

While ketoconazole can theoretically target dermatophytes like Trichophyton (athelet’es foot, jock’s itch) and Microsporum (ringworm or scalp ringworm) species, it is not considered the most effective treatment for these types of fungi due to its fungistatic nature and less robust tissue retention. 

For dermatophyte infections like athlete’s foot, ringworm, and jock itch, other agents such as terbinafine or econazole or clotrimazol are typically more effective. Ketoconazole remains a strong choice for yeast-related conditions but is less favored for dermatophyte infections in clinical practice.

Is it bad to use ketoconazole (Nizoral) every day?

Dr. Fernandez says that using ketoconazole (Nizoral) every day is not inherently harmful if it is used as directed by a healthcare provider. In some cases, such as treating seborrheic dermatitis, daily or frequent use may be recommended initially to control the condition. However, prolonged or unnecessary use can increase the risk of side effects such as skin irritation or the development of fungal resistance. Always follow the instructions provided by your doctor and discontinue use if you experience significant irritation or other adverse effects.

What are the side effects of antifungal creams?

Dr. Fernandez says that antifungal creams, including ketoconazole, can cause potential side effects, although they are generally well-tolerated. Common side effects include mild redness, itching, burning, or stinging at the application site. Less commonly, they may cause allergic reactions, resulting in swelling, rash, or severe itching. Prolonged use or overuse can sometimes lead to skin irritation or sensitivity. Serious side effects are rare but should be addressed immediately by a healthcare provider. If you experience significant discomfort or worsening symptoms, consult your doctor for further advice.

Are there ketoconazole (Nizoral) cream alternatives sold over the counter?

Yes, according to Dr. Fernandez there are several over-the-counter antifungal creams that can serve as alternatives to ketoconazole cream for mild fungal skin conditions. These include clotrimazole (Lotrimin), miconazole (Monistat Derm), and terbinafine (Lamisil). 

These medications are effective against common fungal infections such as athlete’s foot, ringworm, and jock itch. However, if your condition does not improve after 2 weeks of using an over-the-counter anti-fungal creams, you should consult a board-certified dermatologist as you may need prescription-strength treatment or an entirely different medication as your skin rash could not be a fungal infection at all.

How long does it take for ketoconazole (Nizoral) cream to work?

Dr. Fernandez says that the time it takes for ketoconazole cream to work depends on the type and severity of the fungal infection being treated. For most mild fungal or yeast infections, noticeable improvement can occur within 2 to 4 weeks of consistent use. Conditions like seborrheic dermatitis may show improvement within a few days of application. However, more extensive or resistant infections might take longer to resolve, and treatment may need to continue for several weeks to prevent recurrence. It’s important to use the cream as prescribed and complete the full course of treatment, even if symptoms improve, to ensure the infection is fully eradicated.

Do you rub in antifungal cream?

Yes, antifungal cream should be gently rubbed into the affected area. Apply a thin layer of the cream to clean, dry skin, covering not only the visible rash or infection but also a small margin of the surrounding healthy skin to ensure thorough treatment. After applying, rub the cream in gently until it disappears into the skin. Avoid using excessive amounts, as a small amount is usually sufficient. Be sure to wash your hands thoroughly after application to prevent spreading the infection to other parts of your body or to other people.

Article References:
https://www.ncbi.nlm.nih.gov/books/NBK559221/
https://www.mayoclinic.org/drugs-supplements/ketoconazole-topical-route/description/drg-20067739