Ketoconazole Cream | An Antifungal Cream for Malassezia

1. What is ketoconazole cream?

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Ketoconazole cream is an antifungal cream used for conditions involving fungi (molds).

Its active ingredient is ketoconazole, and it is mainly used for seborrheic dermatitis, tinea versicolor, and folliculitis in which Malassezia is involved.

2. How it differs from Nizoral

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It has the same active ingredient as Nizoral, but its uses differ due to differences in formulation.

For the face or body, ketoconazole cream is considered first as it can remain on the lesion for a long time. Nizoral is considered when lesions are widely spread across the scalp, making cream application difficult.

3. Why it is used for Malassezia

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Ketoconazole is not the first medication used for all fungal infections. It is mainly considered for lesions in which Malassezia is involved.

Ketoconazole inhibits the proliferation of Malassezia by interfering with the formation of fungal cell membranes.

• Seborrheic dermatitis: Erythema and scaling recur in sebum-rich areas such as the scalp, T-zone of the face, around the ears, and the chest.
• Malassezia folliculitis: Similar red papules and pustules, 1–2 mm in size, appear along the hair follicles on the forehead, hairline, chest, and upper back. Comedones are often absent or rare, and itching is common. It is suspected if it occurs after antibiotic treatment or does not respond well to acne treatment, but since it can coexist with acne, a diagnosis is not made based on appearance alone.¹
• Tinea versicolor: Light or dark spots appear on sebum-rich areas such as the neck, chest, and back.

Although ketoconazole can be used in dermatophyte infections, other antifungal agents such as terbinafine may generally be more suitable.

4. How to use

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• Apply a thin layer once in the evening to the affected area and surrounding skin.
• If using a moisturizer together, apply the moisturizer first before applying the ketoconazole cream.
• Even if symptoms improve, do not stop immediately; use it for the duration you were instructed during your visit.

The standard for the amount to apply is FTU (Finger-Tip Unit). One FTU is the amount squeezed from an adult’s index finger from the tip to the first joint, and for ketoconazole cream, 1 FTU is sufficient for an area about the size of the face.

5. Precautions when using it

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Stinging, burning, itching, or dryness may occur at the application site. If mild and temporary, you may monitor it, but if swelling, oozing, or severe itching occurs, stop using it and seek medical attention to check for contact dermatitis.

If the lesion does not improve even after the treatment period, it should be reassessed whether Malassezia is truly the main cause and whether other causative fungi or inflammatory conditions are also present.

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References

1. Prindaville B, Belazarian L, Levin NA, Wiss K. Pityrosporum folliculitis: A retrospective review of 110 cases. J Am Acad Dermatol. 2018;78(3):511-514.