Topical antiviral and antifungal medications in pregnancy: a review of safety profiles

Abstract

Medications should be employed with caution in women of childbearing age who are pregnant or considering pregnancy. Compared to oral or parenteral agents, topical medications have limited systemic absorption and are deemed safer. However, their safety profile must be assessed cautiously due to the limited available data. In this article, we aggregate human and animal studies to provide recommendations on utilizing topical antiviral and antifungal medications in pregnancy. For antiviral medications, acyclovir and trichloroacetic acid are safe to use in pregnancy. Docosanol, imiquimod and penciclovir are likely safe, but should be utilized as second-line agents. Podofilox and podophyllin resin should be avoided. For antifungal medications, clotrimazole, miconazole and nystatin are considered first-line agents. Butenafine, ciclopirox, naftifine, oxiconazole and terbinafine may be utilized after the above agents. Econazole should be avoided during the first trimester and used sparingly during 2nd and 3rd trimester. Ketoconazole and selenium sulphide are likely safe, but should be employed in limited areas for brief periods.

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

“…Kaul et al (2017) proved that allylamines and azole antifungal drugs are preferred for topical use in pregnant women, children and the elderly. Additionally, nystatin, miconazole and clotrimazole are safer and should be first-line drugs of choice in pregnant women, while econazole has to be avoided in the first trimester (Patel et al 2017). In the case of systemic therapy, terbinafine has the fewest side effects primarily on the circulatory system; therefore, it is recommended especially in the elderly.…”

“…While the use of a topical antifungal agent is usually sufficient to eliminate the dermatophyte and cure most cases of anthropophilic infections, zoophilic dermatophytoses in humans pose considerable difficulties, especially tinea capitis and tinea unguium, often requiring systemic treatment (Nenoff et al 2019). As with any antimicrobial drug, antifungal agents have adverse effects; consequently, management of superficial dermatophytosis infection has become a real problem in some groups of people, for example, elderly patients, pregnant women and children (Patel et al 2017). An even more complicated problem is posed by dermatophytoses in animals, especially farm animals, which are neglected by breeders and, if left untreated, constitute a source of pathogens that may undergo interindividual transmissions (Łagowski et al 2019a).…”

“…An important feature of substances used in the treatment of superficial mycoses is their easy penetration into the stratum corneum and persistence at a constant concentration throughout the therapy (Khurana et al 2019). Moreover, a vaccine against human dermatophyte infection, which is considered an important element of prevention and the first step in therapy, is currently unavailable (Patel et al 2017;Gnat et al 2019e).…”

Screening of Antifungal Substances from Bovistella Radicata (Mont.) Pat and Their Antifungal Effect

“…Traditionally, to treat tinea pedis, synthetic fungicides such as uconazole, itraconazole, echinocandins [5] , and miconazole nitrate, either by oral medication or external use [6] , have been used to treat this disease. Vermes et al (2000) found that ucytosine and AMB (amphotericin B) were moderately effective in ghting against invasive fungal infections [7][8][9] . Similar studies on Itraconazole have demonstrated that it is effective against fungal infections [10] .…”

Topical skin care – a domain for allergy prevention

“…– of bringing the substances needed into the right mixture with a vehicle so that what is needed can come to where it is needed and in a good time, when it is needed. Also care has to be given to aspects of safety during pregnancy . or contact allergy to ingredients …”