Over the counter antifungal cream are used in the treatment of various conditions including ringworm, nappy rash, athlete’s foot, thrush and other infections caused by yeast (Candida species), mould and other fungi (for example Trichophyton species). This post summarises the use, availability and restrictions of over the counter antifungal cream.
Where to buy over the counter antifungal creams?
Legally, over the counter antifungal creams can be broadly divided into two categories:
- Antifungal creams which are available in supermarkets and pharmacies and can be self-selected by customers. This group of antifungal cream fall into the category of General Sale List Medicines (GSL).
- Antifungal creams with sales restricted to the pharmacy only, which are not available for self-selection by the public. This group of antifungal creams and other medicines are called Pharmacy medicines, P-medicines.
Over the counter antifungal creams from both categories may have the same active ingredient (antifungal drugs) but may have different licensing, for example, age restrictions on the use.
Additionally, antifungal creams are sold under different names, for example, many supermarkets and pharmacies sell their versions of clotrimazole cream which is also available as branded cream, for example, Canesten cream.
What over the counter antifungal creams can be purchased?
There is a wide variety of antifungal products in the UK. The following antifungal drugs can be found in over the counter antifungal creams:
Which antifungal creams do I need?
Two main factors which need to be taken into consideration when deciding on treatment with antifungal cream are:
- Intended use: what fungal infection do you want to treat?
- Age of the patient
Most antifungal creams have the same licensed use, for example, the treatment of athlete’s foot or sweat rashes. Some over the counter clotrimazole creams (1% and 2%) are only licensed for the treatment of thrush, despite the wide use of clotrimazole cream to treat different ‘fungal’ conditions.
Some antifungal creams have age restrictions. Clotrimazole 1% cream and miconazole 2% antifungal cream can be used by all age patients, therefore should be considered as first-line treatment for example in the management of nappy rash. In contrast clotrimazole 2% cream have age restrictions in the treatment of thrush.
Confused? A pharmacist will be able to advise on the best suitable option for the treatment.
Combination creams containing an antifungal agent and hydrocortisone (steroid), for example, Canesten Hydrocortisone (clotrimazole and hydrocortisone) or Daktacort (miconazole and hydrocortisone) should not be used in children under 10 years of age. When prescribed, products containing hydrocortisone can be used by children under 10 years of age.
Verbal recommendation by GP or any other healthcare professional is not sufficient to purchase antifungal creams containing hydrocortisone outside of its licensed age.
What is the best over the counter antifungal cream?
Cochrane reviewed information from all clinical trials which looked at the effectiveness of antifungal creams. A great deal of evidence supports the effectiveness of over the counter antifungal creams. Terbinafine was named the most effective topical antifungal cream. Terbinafine is available in the UK (brand name: Lamisil) in form of creams, gel and solution for the treatment of athlete’s foot and dhobi itch in adults and children over 16 years of age.
Over the counter antifungal creams: list of products
1. Clotrimazole 1% antifungal cream
Over the counter clotrimazole is available as generic clotrimazole cream or as branded Canesten, Canesten Dual Action, and Canesten Athlete’s Foot (the same active ingredient). Clotrimazole cream is also available as own labelled product from larger pharmacy chains or supermarkets, for example, Boots antifungal cream. Some pharmacies sell 1% clotrimazole cream as a thrush cream, however, normally there is no difference between the ‘thrush’ preparation of 1% cream and any other brand of 1% clotrimazole.
Where can you buy clotrimazole 1% antifungal cream?
Clotrimazole 1% cream is licensed as a pharmacy-only medication and general sale item, for example, Canesten Athlete’s Foot, and Canesten Dual Action can be purchased off the shelf in supermarkets.
What is clotrimazole 1% cream used for?
Clotrimazole 1% antifungal cream can be sold specifically for thrush symptoms, for example, Boots 1% Thrush cream, or for Athlete’s Foot, for example, Canesten Athlete’s Foot 1% w/w Cream. Both products contain the same active ingredients. Generic clotrimazole 1% cream (most likely the cheapest option), can also be used for the above symptoms, additionally, it can be used to treat (eMC, 2022):
- Skin infections due to moulds and other fungi (for example, Trichophyton species)
- Skin infection due to yeast (Candida species)
- Nappy rash
- Vulvitis (inflammation of the vulva)
- Balanitis (swelling of the head of the penis)
Clotrimazole 1%: age restrictions
There are no specific age restrictions for clotrimazole 1% cream. Clotrimazole 1% cream is licensed for babies, young children and the elderly. Clotrimazole 1% cream is commonly used to help with the treatment of nappy rash in babies and toddlers.
How often and how long does clotrimazole 1% antifungal cream needs to be used for?
Over the counter clotrimazole antifungal cream is usually applied 2-3 times a day. The duration f the treatment depends on the type of infection treated, for example, clotrimazole cream should normally be applied for at least two weeks to treat candida infections, like nappy rash.
2. Clotrimazole 2% antifungal cream
Over the counter clotrimazole antifungal cream is available as a 2% preparation (double the strength as compared to 1% clotrimazole cream) sold under the brand name Canesten Thrush External Cream.
2 % clotrimazole antifungal cream is licensed for the treatment of candidal vulvitis and candidal vaginitis (thrush). Canesten 2% Thrush cream can also be used by a sexual partner to prevent re-infection.
Where can you buy clotrimazole 2% antifungal cream?
Canesten Thrush External cream is a pharmacy-only medication, which can be purchased from pharmacies only (kept behind the counter), including online chemists.
Canesten 2% thrush cream: age restrictions
Patients aged under 16 or over 60 years should seek medical advice before using Canesten 2% thrush cream.
How often and how long does Canesten 2% thrush cream needs to be used for?
The cream should be applied two to three times a day until patients are free of symptoms unless the cream is used alongside other treatments for vaginitis. In this case, it is recommended to see a doctor if symptoms do not improve within seven days of the treatment.
3. Clotrimazole and hydrocortisone cream (Canesten Hydrocortisone)
It is possible to buy a combination cream containing an antifungal drug, clotrimazole, and hydrocortisone, which is a mild steroid. Canesten Hydrocortisone and Canesten Hydrocortisone Athlete’s Foot 1% contains a combination of 1% clotrimazole and 1% hydrocortisone.
Addition of mild steroid in the formulation help with some symptoms of fungal skin infections such as inflammation, redness and itching.
Canesten products containing both active ingredients are licensed for the treatment of:
- Athlete’s foot and
- Candidal intertrigo (fungal infection located in between folds of adjoining skin)
Canesten Hydrocortisone: age restrictions
Children under 10 years of age should not be used over counter Canesten Hydrocortisone unless prescribed by a doctor.
How often and how long can I use Canesten Hydrocortisone cream for?
Canesten Hydrocortisone is usually applied twice a day for a maximum period of 7 days. Hydrocortisone-containing products should be applied thinly and evenly.
Other important information
There are several important directions for the use of Canesten Hydrocortisone cream. For more information, please refer to the product information leaflet.
4. Miconazole containing antifungal creams
There are a number of antifungal creams containing miconazole. The table below summarises the availability of different brands of miconazole creams including a combination cream of miconazole and hydrocortisone.
|Active drug||Brand name||Where to buy||Age restrictions|
|Miconazole 2%||Daktarin 2% Cream||Pharmacy only product, not available for self-selection||No minimum age specified. Can be used in babies for example to treat nappy rash.|
|Miconazole 2%||Daktarin Aktiv Cream||Available for self selection from supermarkets and pharmacies||For all ages.|
|Miconazole 2% and hydrocortisone 1%||Daktacort Hydrocortisone cream||Pharmacy only product, not available for self-selection||Children 10 years of age and above|
What can you use miconazole-containing antifungal creams for?
Daktarin Aktiv cream (GSL) is licensed for the treatment of athlete’s foot whereas Daktarin 2% cream (P) is licensed for the management of fungal infections of skin and nails and superinfections caused by Gram-positive bacteria. Daktarin cream (pharmacy only medicine) is usually kept in the dispensary, therefore one needs to ask a member of a pharmacy team specifically for Daktarin cream.
Miconazole antifungal creams: dosage and duration of the treatment
Daktarin is normally used twice daily with a recommended duration of treatment of at least one week after symptoms are resolved. Check the product information leaflet for more details, as recommended dosage may vary between different treatments.
Similarly to other antifungal creams containing hydrocortisone, Daktacort hydrocortisone is indicated in athlete’s foot and candidal intertrigo (fungal infection located in between folds of adjoining skin) with symptoms of inflammation, redness in itchiness. Daktacort is also licensed for skin infections associated with gram-positive bacteria, such as Streptococcus and Staphylococcus.
Daktacort hydrocortisone cream should be used for up to 7 days. It is possible to use Daktarin cream after Daktacort cream after symptoms of inflammation are resolved.
5. Over the counter ketoconazole cream
Ketoconazole is sold over the counter as branded products:
- Daktarin Intensiv Cream, available as a general sale item for self-selection in pharmacies and supermarkets
- Daktarin Gold 2% cream, available as pharmacy-only medication, not available for self-selection
Both Daktarin Intensiv and Daktarin Gold creams contain the same amount of ketoconazole in the formulation (2%).
Both creams are licensed in the treatment of athlete’s foot and dhobie itch (tinea cruris). Daktarin Gold has an additional licensed indication of sweat rashes.
Ketoconazole cream: age restrictions
Daktarin Intensiv and Daktarin Gold creams are licensed for adult use only.
How often and for how long should you use Daktarin creams (ketoconazole)?
Product information for both above products recommends once or twice daily applications for 4-6 weeks. Patients should see a doctor if no improvement in symptoms is achieved in 4 weeks.
5. Over the counter antifungal creams: terbinafine
Terbinafine cream brands and availability
Terbinafine 1% cream is available as a general sale item in the following brands:
- Lamisil AT 1%
- Boots Athlete’s Foot 1%w/w Cream
- Scholl Advance Athlete’s Foot Cream
All the above brands of terbinafine cream are general sale items, available for self-selection by patients from supermarkets and pharmacies.
Terbinafine cream: uses
Terbinafine antifungal cream is used for the treatment of:
- Athlete’s foot
- Dhobie itch
Terbinafine cream age restrictions
All brands of over the counter terbinafine antifungal cream are licensed for adults and children 16 years of age and over.
How often and how long to apply terbinafine cream
Terbinafine is usually applied once daily for one week.
Terbinafine is also available in the form of a solution, sold as Lamisil Once. Lamisil Once is licensed for the treatment of athlete’s foot in adults 18 years of age and over.
In the treatment of athlete’s foot, Lamisil Once requires one application only.
eMC (2022). SmPC: Canesten Cream. Available at: https://www.medicines.org.uk/emc/product/1282/smpc Accessed on 16/11/2022
eMC (2022). SmPC: Canesten Thrush External Cream 2% w/w cream. Available at: https://www.medicines.org.uk/emc/product/2206/smpc Accessed on 16/11/2022