Topical antifungal (hydroxypyridone class)
Brand names: Loprox, Penlac, Ciclodan
Updated · Methodology
First line
First-line topical antimycotic for onychomycosis, dermatophytosis of glabrous skin, tinea versicolor and skin candidiasis. 8% nail lacquer once daily for 6–12 months in onychomycosis with under 50% nail involvement and no matrix involvement. AEMPS positions it as an alternative to systemic terbinafine when contraindicated.
Sources
ICD-10: B35 · ICD-11: 1F28
Hydroxypyridone with a mechanism distinct from azoles. Chelates trivalent cations (Fe³⁺, Al³⁺) required for fungal cytochrome, catalase and peroxidase activity. Additionally disrupts ATP synthesis and amino acid transport. Broad spectrum: dermatophytes, yeasts (Candida, Malassezia), moulds, gram-positive bacteria. Low systemic absorption with topical use.
AEMPS summary of product characteristics (section 4.6): there are no data on the use of ciclopirox olamine in pregnant women. Animal studies do not indicate direct or indirect harmful effects related to reproductive toxicity, but data on possible long-term effects on postnatal development are insufficient. As a precaution, it is preferable to avoid ciclopirox during pregnancy.
Compatible. Hale L2. Minimal systemic absorption. When applied to the nipple for dermatophytosis or nipple candidiasis, wipe residue before feeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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Ciclopirox is evaluated for the following indications with varying evidence strength: Superficial fungal infections (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ciclopirox (≥ 1 in 100): Burning and itching at the application site, Erythema, Contact dermatitis. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): there are no data on the use of ciclopirox olamine in pregnant women. Animal studies do not indicate direct or indirect harmful effects related to reproductive toxicity, but data on possible long-term effects on postnatal development are insufficient. As a precaution, it is preferable to avoid ciclopirox during pregnancy.
Compatible. Hale L2. Minimal systemic absorption. When applied to the nipple for dermatophytosis or nipple candidiasis, wipe residue before feeding.
Ciclopirox is contraindicated in: Hypersensitivity to ciclopirox; Under 6 years of age (nail lacquer form). Full list in the Safety section.
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