Antifungal Creams: Which Drug to Choose, How Many Weeks to Apply It, and Which to Use Where, Explained by a Dermatologist
A topical antifungal is a medicine applied to the skin that damages the fungal cell wall. It is used for superficial fungal skin infections such as ringworm of the body (tinea corporis), jock itch (tinea cruris), athlete's foot (tinea pedis) and tinea versicolor (pityriasis versicolor). The key to choosing is not the brand but the active ingredient, the site affected, and how long you keep applying it, and most people get all three wrong at once.
This article follows the questions patients actually ask in the clinic: how the drug groups differ, which one to use on which site, how long is long enough, why the rash improves and then comes back, and when a cream is no longer the answer.
How many groups of antifungal cream are there, and how do they differ?
The creams actually used in Thailand fall into 4 main groups. What matters for treatment is which groups kill the fungus (fungicidal) and which only hold it back (fungistatic), and that each group covers different organisms.
Azoles — clotrimazole, miconazole, ketoconazole, econazole, bifonazole. They cover both filament-forming fungi (dermatophytes) and Candida yeast, and are the most broadly useful group.
Allylamines — terbinafine, naftifine. They kill dermatophytes more strongly than azoles, so treatment is shorter, but they are weaker against Candida.
Hydroxypyridones — ciclopirox. Available as a cream and as a nail lacquer, with broad coverage and a mild anti-inflammatory effect.
Polyenes — nystatin. It works only on Candida yeast and has no effect on ringworm fungus, which is a common reason for treatment failure when the wrong group is picked up.
Two other products outside these four groups are also commonly used in Thailand: sodium thiosulfate 20% and selenium sulfide 2.5%. Both are used mainly for tinea versicolor, not for ringworm.
Why choose by active ingredient, not by brand
The question people search most is which brand is best. In practice, the dozens of antifungal brand names sold in Thai pharmacies revolve around just a few active ingredients. Two tubes whose prices differ several times over may contain the same ingredient at the same strength.
What to read on the box is the line giving the active ingredient and its strength, for example clotrimazole 1% w/w or terbinafine hydrochloride 1% w/w, and then match it to the site affected using the sections below. There is no single "best" one, because the cream that suits the toe webs is not the one that suits the groin in someone with thin, damp skin.
A more important caution than the brand: some tubes are combination creams that also contain a steroid. That is a different thing from a plain antifungal, and it is the number one reason fungus spreads silently. Details are in the section on steroid combination creams below.
Azoles — clotrimazole, miconazole, ketoconazole
How it is used: This is the easiest group to buy and the broadest in use. It suits cases where you are not sure whether the cause is a dermatophyte or Candida, and it suits warm, damp areas under clothing, where Candida is often present too.
Doses and directions in practice:
Clotrimazole 1% cream — apply twice a day, morning and bedtime.
Miconazole 2% cream — apply twice a day. A dusting powder is also available for the toe webs and for shoes.
Ketoconazole 2% cream — apply once or twice a day. A shampoo form is also available for tinea versicolor and the scalp.
Bifonazole 1% cream — apply once a day at bedtime, convenient for people who cannot manage twice a day.
Duration: ringworm of the body and jock itch 2–4 weeks · athlete's foot between the toes 4 weeks · Candida in skin folds 2–3 weeks. In every case keep applying for another 1–2 weeks after the rash has completely cleared.
When to see a doctor: no improvement at all after 4 weeks of application, the rash spreads while you are using the cream, there are pustules, or the rash appears in someone with diabetes or taking immunosuppressants.
Allylamines — terbinafine cream
How it is used: Terbinafine 1% cream directly kills ringworm fungus rather than just holding it back, so treatment is clearly shorter than with azoles, and the drug stays in the outer skin layer for several weeks after you stop applying it.
Dose and directions: apply once or twice a day.
Ringworm of the body and jock itch — 1–2 weeks.
Athlete's foot of the moist, peeling toe-web type — 1 week. For the type that peels across the whole sole (moccasin type), apply for 2–4 weeks.
Limitation to know: its effect on Candida yeast is clearly weaker than azoles. For a red, weepy rash in skin folds, under the breasts or in the groin creases of people who are overweight, where Candida is often present, terbinafine may work less well and an azole is more suitable.
When to see a doctor: after 2 weeks the edge of the rash is still raised and clearly red, or the rash turns into pustules around the hair follicles, which may be a fungal infection that has gone deep to the hair root (Majocchi granuloma) where a cream cannot reach.
What fungi does nystatin work on?
Many households keep nystatin because they were given it when a child had a diaper rash or oral thrush. The point to understand correctly is that nystatin works only on Candida yeast and does not work at all on ringworm, tinea versicolor, jock itch or athlete's foot.
Works well for: diaper rash with Candida on top, a red weepy rash under the breasts or in skin folds in people who are overweight, and oral thrush.
Does not work for: a red ring-shaped rash with a raised edge on the body, a groin rash spreading in a ring, or a rash between the toes.
If you put nystatin on ringworm and the rash is no better within a week, the problem is not a resistant fungus. It is that the wrong group was chosen from the start.
Nail treatments — amorolfine and ciclopirox
Nature of the problem: The nail is hard tissue that an ordinary cream cannot penetrate. Nail treatments are therefore special nail lacquers that stick to the nail plate and release the drug slowly.
Amorolfine 5% nail lacquer — apply once or twice a week, continuously for 6 months for fingernails and 9–12 months for toenails.
Ciclopirox 8% nail lacquer — apply daily, wipe off with alcohol once a week, and continue for up to 48 weeks.
Urgency and realistic expectations: A nail lacquer alone has a low chance of clearing the infection, and suits only cases where the fungus covers no more than half the nail, does not reach the nail base, and affects no more than 2–3 nails. Beyond that, the standard approach is an oral medicine such as oral terbinafine 250 mg once a day for 6 weeks for fingernails and 12 weeks for toenails, which must be prescribed and monitored by a doctor because liver function and other medicines being taken need to be assessed.
When to see a doctor: before starting any treatment whenever you suspect a nail fungus, because a thick yellow nail has many other possible causes. You can read how to tell them apart in the article What causes nail fungus.
Tinea versicolor — ketoconazole shampoo, selenium sulfide and sodium thiosulfate
Nature of the problem: Tinea versicolor appears as pale or brown patches that shed fine scale when scraped, usually on the back, chest, neck and upper arms. It is caused by Malassezia yeast that already lives on everyone's skin, so it is treated differently from ringworm.
Products that match this condition:
Ketoconazole 2% shampoo — apply over a wide area of wet skin, leave on for 5 minutes, then rinse off. Once a day for 5 days in a row (rinsing off straight away is the most common reason treatment fails).
Selenium sulfide 2.5% — used the same way, left on for 5–10 minutes, once a day for 7 days.
Sodium thiosulfate 20% (tinea versicolor lotion) — apply twice a day for 2–4 weeks. Suitable for small, patchy areas.
Realistic expectations: Once the fungus is dead, the pale patches remain for another 2–6 months because the pigment has to regrow naturally. White patches still visible after the full course therefore do not mean the medicine failed. To check whether the fungus is still present, scrape gently and see whether fine scale still comes off. Details of the condition are in the article What causes tinea versicolor.
When to see a doctor: it returns every summer for several years in a row, the rash covers the whole back and chest, or you cannot tell it apart from vitiligo and pityriasis alba.
Ringworm of the trunk, arms and legs — what to apply and for how long
Appearance: A round or oval rash with a clearly raised red edge and scale, often paler in the middle. It itches more when you sweat and slowly widens outward over weeks.
Drugs to use: terbinafine 1% once or twice a day for 1–2 weeks, or an azole such as clotrimazole 1% twice a day for 2–4 weeks. Apply at least 2 centimetres beyond the edge of the rash on all sides, because fungus is always present outside the edge the eye can see.
Urgency: Not an emergency, but it spreads through towels and bedding. Keep towels and linen separate and wash them in hot water during treatment.
When to see a doctor: the rash is in more than 3 places, wider than the palm, on the face, or you have applied a steroid before and the edge of the rash is no longer clear. Read more at What causes ringworm.
Jock itch and fungal rashes under clothing — why azoles are often more suitable
Appearance: A red itchy rash in the groin and inner thighs with a clear edge, usually spreading down the thigh unevenly on the two sides. In men it usually spares the scrotum. A rash from Candida is usually redder and weepier, with an unclear edge and small spots scattered around it.
Drugs to use: An azole is the first choice when you cannot tell whether it is ringworm fungus or Candida, because it covers both. Apply twice a day for 2–4 weeks. If you are sure it is jock itch from ringworm fungus, terbinafine 1% for 1–2 weeks is enough.
Duration and conditions that make it really clear: Always treat athlete's foot at the same time, because fungus between the toes travels up through the underwear every day. Switch to breathable cotton underwear and dry the body completely before dressing.
When to see a doctor: it returns within a month of stopping treatment, the rash spreads to the buttocks or around the anus, or there are pustules. Read more at What causes jock itch.
Athlete's foot and fungus between the toes
Appearance: There are three types, treated with different drugs: the moist, white, peeling toe-web type (the most common), the dry type that peels across the whole sole like a moccasin, and the type with clusters of clear blisters on the sole.
Drugs to use:
Toe-web type — terbinafine 1% once a day for 1 week, or an azole twice a day for 4 weeks.
Whole-sole peeling type — apply for 4 weeks or more, and it often needs a scale-softening agent such as urea or salicylic acid alongside, so that the drug can get through the thick outer skin layer.
Blister type — dry the area with compresses first, then apply the drug.
What people overlook that makes it come back: Dust antifungal powder into the shoes and rotate your shoes so you do not wear the same pair two days in a row, because spores can live in shoes for months.
When to see a doctor: the foot is swollen, red, hot and painful (possibly a secondary bacterial infection), you have diabetes, or the rash does not improve in 4 weeks. It should also be clearly separated from non-fungal dermatitis caused by soaking in water, which is described in What causes athlete's foot.
Scalp fungus — a cream is never enough
Appearance: Patches of hair loss with thick scale, hairs broken short at scalp level so they look like black dots, and in some cases a soft swollen boggy lump with pus (kerion). It is most common in school-age children.
What you need to understand: The fungus lives in the hair root, deeper than a cream can reach. The standard treatment is always an oral medicine, such as griseofulvin or oral terbinafine for 6–8 weeks, depending on body weight and the type of fungus. Ketoconazole 2% shampoo or selenium sulfide is used 2–3 times a week only to reduce spread, not to treat the infection.
Urgency: See a doctor from the start, because if it is left until a kerion forms, scarring and permanent hair loss can result. Details are in Scalp ringworm (tinea capitis).
Facial fungus — why extra care is needed
Appearance: A red scaly rash on the cheeks, nose or around the eyebrows that looks very much like an allergic rash, seborrheic dermatitis and other skin inflammation, so it is easily misdiagnosed, both by patients and from photos.
Drugs to use: If a doctor confirms it is a fungus, a mild azole such as clotrimazole 1% or ciclopirox cream is used twice a day for 2–4 weeks. Facial skin is thinner than the body, so it is irritated more easily.
Urgency: Do not experiment with treatment on the face yourself. If the rash is another type and you keep applying an antifungal, you lose several weeks, and if you happen to use a steroid combination cream on the face, thinned skin and dilated fine blood vessels can result that are hard to fix. Read more at The dangers of misusing steroid creams on the face.
How to apply the cream so it works — the 6 steps people get wrong most often
Wash and dry the skin completely before applying. Leftover moisture lets the fungus keep growing and dilutes the drug.
Apply 2 centimetres beyond the edge of the rash. Fungus is always outside the edge the eye can see. Applying only where it is red is why the rash keeps widening even while you are using the cream.
Apply a thin layer, but cover the whole area. It does not need to be thick. Too much cream adds no benefit but traps moisture.
Apply the full number of times a day as directed. Twice a day means about 12 hours apart, not twice in a row in the morning.
Keep applying for another 1–2 weeks after the rash has completely cleared. The rash always clears before the fungus is dead. This is the step most often neglected and the number one reason for relapse.
Wash your hands after every application so that you do not carry the fungus to other sites.
How long to apply, and how to know the drug is working
Signs that the drug is working, which you should see within the first 7–14 days, are less itching, less scale at the edge of the rash, the edge becoming flatter and paler, and the rash no longer widening.
Signs that it is not working and you need to rethink are: the rash keeps widening even though you have applied it regularly for 2 weeks, the rash becomes redder and stings (possibly irritation from the drug itself), new pustules appear around the hair follicles, or it improves very quickly within 2–3 days and then gets worse, which often suggests the cream contains a steroid.
Duration at a glance: ringworm of the body 2–4 weeks (terbinafine 1–2 weeks) · jock itch 2–4 weeks · athlete's foot between the toes 1–4 weeks · whole-sole peeling type 4 weeks or more · tinea versicolor 5–7 days for shampoo or 2–4 weeks for lotion · nails 6–12 months.
Steroid combination creams — the most common problem in this area
Combination creams that put an antifungal and a steroid in one tube are picked up often because the itch drops straight away within a day or two. But a steroid suppresses inflammation, which is the mechanism the body uses to limit the fungus. The result is that the rash looks better while the fungus silently spreads wider, a condition called tinea incognito.
Features that should make you suspect tinea incognito: the edge of the rash is less clear than usual ringworm, the rash is wide and irregular, there are small pustules around the hair follicles, the skin there has become thinner with visible fine blood vessels, and a history that the cream always helped, but when stopped the rash came back worse than before.
What to do: Combination creams do have a place in some cases, and that should be a doctor's decision, not a medicine you pick up yourself and use continuously for weeks. If you are not sure whether the tube you are holding contains a steroid, read the ingredient names on the box. Names ending in -sone, -solone or -onide, such as betamethasone, triamcinolone and clobetasol, are steroids.
Why does it improve and then come back?
When the rash returns to the same place within a few weeks, the cause is usually not a resistant fungus but one of these 5 things.
Stopping the cream too early — stopping the moment the rash looks gone, while the fungus is still in the outer skin layer.
Not covering every site — treating jock itch but not the toe webs, which are the original source of the fungus.
Belongings still carry the fungus — shoes, socks, towels, bedding, nail clippers.
The damp conditions are unchanged — tight clothing that does not breathe, closed shoes all day, not drying the body after a bath.
A person or pet at home is still infected — especially fungus from cats and dogs, which can keep passing it back.
How to break the cycle: treat every site at the same time, keep applying for 1–2 weeks after the rash clears, wash laundry in hot water and dry it in the sun, rotate shoes, and take pets with patchy hair loss to a veterinarian.
Where to buy antifungal cream, and do convenience stores sell it?
Most topical antifungals are classed as modern-medicine drugs that must be dispensed in a pharmacy with a pharmacist, not as household medicines, so convenience stores do not generally sell them. Buying from a pharmacy has the advantage that you can talk with the pharmacist about the site affected and how long to apply, the two things that decide the result more than the brand.
What to tell the pharmacist so you get the right drug: the site affected, what the rash looks like (a ring with a clear edge, red and weepy, or pale patches with fine scale), how long you have had it, what you have already applied, and whether you have any underlying condition or are pregnant.
For pregnant and breastfeeding women: a topical azole over a limited area is considered acceptable in practice, but a doctor or pharmacist should confirm it each time before use, and avoid applying it to the breast area while breastfeeding.
When to stop treating it yourself and see a doctor
You have used the right group regularly for 4 weeks with no improvement, or it gets worse during treatment
A rash on the face, scalp or nails, where an ordinary cream is usually not enough
A rash wider than the palm, or in more than 3 places
Pustules, swollen red hot skin, fever or severe pain
You have diabetes, take immunosuppressants, are having chemotherapy, or have low immunity
A rash in young children and infants, especially on the scalp
You have applied a steroid-containing cream to the area before and the edge of the rash is no longer clear
Choosing an antifungal, its strength and the right duration is a medical decision that needs the actual rash to be examined together with your history and underlying conditions. This article gives information for understanding and is not a prescription to use medicine in place of an examination.
Short summary
Choose a drug by the active ingredient and the site affected, not by brand or price.
Azoles cover both ringworm fungus and Candida broadly, and suit rashes under clothing and cases where you are unsure.
Terbinafine works faster on ringworm and athlete's foot but is weaker on Candida, while nystatin works only on Candida.
Tinea versicolor, nails and the scalp each need a different approach from ringworm, and the scalp always needs an oral medicine.
Apply 2 centimetres past the edge of the rash and keep applying for another 1–2 weeks after the rash has completely cleared.
Beware of steroid combination creams, which make symptoms improve quickly while the fungus spreads silently.
If you can remember only one thing: read the active ingredient on the box before you buy, and do not stop applying on the day the rash clears.
Frequently asked questions
Which brand of antifungal cream is best?
Medically, the choice is not made by brand but by the active ingredient and its strength, because many brand names in Thai pharmacies revolve around only a few active ingredients. The practical rule is: a ring-shaped rash with a clear edge on the body or groin, use terbinafine 1% or an azole such as clotrimazole 1% · a red weepy rash under clothing where Candida is suspected, use an azole · tinea versicolor, use ketoconazole 2% shampoo or sodium thiosulfate 20% · nails and scalp need a doctor's assessment. What to check before buying is the label, to see whether a steroid is mixed in, because combination creams can let the fungus spread even though the symptoms look better.
Which creams treat both itching and fungus?
Separate the two issues first. The drugs that kill fungus are the azoles, allylamines and ciclopirox, while the itch gradually eases by itself within 1–2 weeks once the fungus is cleared. Some antifungals, especially ciclopirox, have a mild anti-inflammatory effect and so help the itch a little. If the itch is bad enough to disturb sleep, a doctor may add an oral antihistamine. What you should not do is pick up a steroid cream yourself to stop the itch quickly, because it suppresses inflammation until the rash spreads wider while appearing to improve.
What antifungal is used for women?
First separate whether it is a rash on the outer skin or a vaginal infection, because they use different forms of medicine. A red itchy rash in the groin, inner thighs or outer skin folds is treated with a topical azole such as clotrimazole 1% twice a day for 2–4 weeks. A thick white curd-like discharge with itching inside the vagina is a vaginal Candida infection, treated with pessaries or oral medicine as assessed by a doctor or pharmacist, not with an ordinary skin cream. If it recurs more than 4 times a year, see a doctor to look for risk factors such as diabetes.
What tinea versicolor creams does 7-Eleven sell?
Ordinary convenience stores do not sell antifungals, because this class is not a household medicine and must be bought from a pharmacy with a pharmacist. The products used for tinea versicolor and available in pharmacies are ketoconazole 2% shampoo, applied to wet skin, left on for 5 minutes and rinsed off, once a day for 5 days · selenium sulfide 2.5%, used the same way · and sodium thiosulfate 20% lotion, applied twice a day for 2–4 weeks. Note that the pale patches remain for another 2–6 months after the fungus is dead, which does not mean the medicine failed.
Which cream for ringworm and tinea versicolor is best?
This is hard to answer because ringworm and tinea versicolor are different diseases that use different medicines. Ringworm is caused by filament-forming fungi and is treated with terbinafine 1% cream for 1–2 weeks or an azole for 2–4 weeks. Tinea versicolor is caused by yeast on the skin and is treated with ketoconazole 2% shampoo or sodium thiosulfate 20%. Using the medicine for one disease on the other therefore works less well. A basic way to tell them apart: ringworm is a ring with a raised, clearly red edge and a lot of itching, while tinea versicolor is pale or light brown patches with a flat edge, little itching, and fine scale when scraped gently.
What kind of itching is fungal?
Fungal itching usually comes with three things: an edge that is clearer than the centre, scale or flakes at the edge, and slow widening outward over weeks. It usually itches more when you sweat or in damp conditions, and it usually starts at one site before spreading. This differs from hives, which are raised patches that move around and clear within hours; from eczema, which usually appears symmetrically on both sides in the skin folds; and from scabies, which itches severely at night while others at home itch at the same time. If you are not sure, a skin scraping examined under the microscope takes a few minutes and gives a more certain answer than guessing from a photo.
References
Gupta AK, Foley KA, Versteeg SG. Topical antifungal agents. Dermatologic Clinics.
Kaushik N, Pujalte GGA, Reese ST. Superficial Fungal Infections. Primary Care: Clinics in Office Practice.
Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and Management of Tinea Infections. American Family Physician.
Guidelines for the management of fungal skin infections, Dermatological Society of Thailand
Gupta AK, Venkataraman M. Antifungal resistance in superficial mycoses. Journal of Dermatological Treatment.
See an overview of all common skin conditions in 30 common skin conditions. And if you are not sure whether your rash is fungal or another type, read how to choose a cream for an ordinary itchy rash in Creams for itchy rashes: how to choose correctly.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed September 7, 2026
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