Ciclopirox is an old but efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Even though it has significant beneficial properties over many other major topical antifungals used, it remains underutilized.

The pleiotropic effects and many unique properties of ciclopirox justify its resurgence as a topical antifungal. Used in 1% concentration, it is a broad-spectrum antifungal medication with additional antibacterial and anti-inflammatory properties. The antifungal spectrum of ciclopirox is one of the broadest and includes nearly all clinically relevant fungi (dermatophytes, yeasts, and moulds). It is also effective against many azole-resistant dermatophytes and Candida albicans and non-albicansCandida species like C. glabrata and C. krusei.

Ciclopirox is a fungicidal agent which chelates trivalent metal cations especially iron resulting in inhibition of metal-dependent enzymes that protect the fungal cell by scavenging reactive oxygen species, disrupts cellular activities like mitochondrial electron transport processes, inhibits intracellular transport of precursors by cell membrane changes, and disrupts DNA repair. The action of ciclopirox at multiple levels is unique to it and ameliorates the chances of developing drug resistance, which has not been reported to date in any clinical studies. Besides, the drug also has potent antibacterial and anti-inflammatory effects on par with hydrocortisone. 1% ciclopirox olamine cream is equivalent to 0.77% ciclopirox, which penetrates the deep layers of the skin and mucosa. It is indicated for dermatophytosis, pityriasis versicolor, seborrheic dermatitis, vulvovaginal and cutaneous candidiasis, usually administered as twice a day application for 2 to 4 weeks.

Reference: Sonthalia S, Agrawal M, Sehgal VN. Topical ciclopirox olamine 1%: revisiting a unique antifungal. Indian Dermatol Online J. 2019; 10(4): 481-485.