A recent article published in the Indian Dermatology Online Journal stated that ciclopirox olamine (CPO) is a hydroxypyridone derivative that differs in structure and mechanism of action from the other known antifungal agents. This topical antifungal agent has been used for over three decades and has received its US-FDA approval in June 2004.

This drug is also available as a nail lacquer formulation—used for the treatment of onychomycosis, as well as a topical cream formulation. The pleiotropic effects and certain unique properties of CPO make it an effective topical antifungal. A phase III study on the use of 1% CPO cream in the pediatric population reported excellent safety profile in 95% of the children enrolled. Interestingly, 92% cases showed clinical improvement within a week of application. Therefore, CPO cream is a safe and feasible treatment option for superficial cutaneous mycotic infections, especially Candida spp. infection, in children aged between 3 months and 10 years.

Local adverse events reported are minor and have rarely led to discontinuation of therapy or an allergic contact dermatitis. CPO compares very well with oral antimycotic agents in terms of the benefit/risk ratio because of its excellent tolerability and complete absence of serious adverse effects. It is a pregnancy category B drug and safe to use in patients over 10 years of age.

This article inferred that the unique mechanism of action; in vitro and in vivo efficacy; broad-spectrum antimycotic coverage; additional anti-bacterial and anti-inflammatory activity; well-established safety and excellent tolerance; lack of drug resistance coupled with an extremely low likelihood of the development of resistance in future; and easy affordability make CPO cream potentially an ideal topical antifungal for superficial cutaneous mycoses.

The drug is efficacious against recalcitrant superficial fungal infections. Hence, the use of CPO can be aid in reducing the menace of steroid-abuse and management of treatment-refractory dermatophytic infections, tinea incognito, mixed infections and recurrent vulvovaginal candidiasis (VVC).

Source: Indian Dermatology Online Journal. 2019;10(4):481-485. doi:10.4103/idoj.IDOJ_29_19