Medication

Clotrimazole

Clotrimazole is an antifungal cream you can buy without a prescription. It treats both the ringworm family of fungi and Candida yeast, which is why it works in skin folds where some other antifungals do not.
At a Glance

Clotrimazole is a cheap, widely available antifungal cream. It covers both dermatophytes — the fungi behind ringworm, jock itch and athlete's foot — and Candida, the yeast that moves into warm, damp skin folds. That broad coverage makes it a sensible first choice when you are not certain which one you have. The catch is the course: two to four weeks of twice-daily use, roughly twice as long as terbinafine, and the itch settles long before the fungus is gone.

Key Facts

Drug ClassTopical azole antifungal
Other NamesLotrimin AF cream, Canesten, Mycelex, Gyne-Lotrimin, Lotrisone (with a steroid), clotrimazole 1%
Prescription OnlyNo. The 1% cream, solution, powder and vaginal products are over the counter. The combination with betamethasone (Lotrisone) is prescription.
Typical CourseA thin layer twice a day for 2 to 4 weeks, continuing 1 to 2 weeks after the skin looks normal
CostAbout $4 to $12 for a 1 oz tube. Store-brand clotrimazole is the same 1% strength as the branded tube and usually a third of the price.

How It Works

Fungi and yeasts build their outer wall — the cell membrane — from a fatty substance called ergosterol. Clotrimazole blocks the enzyme they need to make it. Without enough ergosterol the membrane leaks, and the fungus cannot grow or divide properly.

All the azole antifungals work this way, and it is why clotrimazole covers such a wide range: the dermatophytes behind ringworm, jock itch and athlete's foot, and Candida, the yeast that grows in warm, damp folds. Mostly it stops fungus growing rather than killing it outright. That is the practical difference from terbinafine, and it is why courses run longer. Your own skin still has to shed the infected layer, and that takes weeks whichever cream you use.

What It Treats

Strong evidence
Clotrimazole covers both dermatophytes and Candida, which makes it a sensible first choice for skin-fold rashes where the exact organism is not confirmed.
Strong evidence
Clotrimazole is a first-line over-the-counter option for ringworm, jock itch and athlete's foot. It works well but needs a longer course than terbinafine.
Strong evidence
Clotrimazole is a first-line over-the-counter option for tinea pedis. Effective, but requires around four weeks of twice-daily use, so adherence is the main limitation.
Strong evidence
Clotrimazole treats the fungal infections that commonly follow constantly moist skin in hyperhidrosis, particularly on the feet and in skin folds.
Moderate evidence
Clotrimazole is an azole antifungal active against Malassezia. In folliculitis it is used for limited areas; larger involvement is treated with a wash or an oral antifungal.
Moderate evidence
Clotrimazole is effective against Malassezia and is a reasonable option for limited pityriasis versicolor. Body surface area makes cream impractical for widespread disease.

Who It's For & Who It's Not

Who it's for

Ringworm, jock itch and athlete's foot on the skin.

Rashes in skin folds — under the breasts, in the groin, under a belly fold — where Candida is likely and you cannot be sure what is growing.

Small patches of tinea versicolor or fungal acne, where a whole-body wash would be overkill.

Anyone who wants an effective antifungal without seeing a doctor first.

Who it's not for

Fungal nail infection. It cannot get through the nail plate and will not cure a nail.

Scalp ringworm. No cream reaches fungus growing inside the hair — that needs a pill.

A rash covering a large area, like a whole back. Cream becomes impractical and a medicated wash or a tablet is easier.

Anyone who has reacted to clotrimazole or another azole cream before.

How to Take It

How much and how often
  • A thin layer, twice a day, rubbed in until it disappears. More cream does not work faster. What matters is covering the whole area properly, twice a day, every day.
Go past the visible edge
  • Fungus spreads outward beyond what you can see. Cover about an inch (two centimetres) past the border of the rash on every side. On the feet, treat the whole foot — sole, sides and between every toe — not just the patch that itches.
Keep going after it looks better
  • This is where most treatment fails. The itch usually settles within a week and the rash can look gone well before the fungus is. Keep applying for one to two weeks after the skin looks normal. For athlete's foot that means about four weeks in total.

What to Avoid

Steroid creams on the same patch, unless a doctor has told you to. Hydrocortisone takes the itch away but lets the fungus spread, and a fungal rash treated with steroid alone changes shape until it is hard to recognise.

Tight dressings or plastic over the treated area, unless advised. They push more drug into the skin and raise the chance of irritation.

Getting it in your eyes. Rinse with water if you do.

Putting clean, treated feet back into untreated shoes. Use an antifungal powder or spray in your shoes while you treat the skin, or you walk straight back into it.

Latex condoms and diaphragms in the 72 hours after using the vaginal cream or pessary. The oily base weakens latex and it can fail. This does not apply to the skin cream.

There are no meaningful interactions with medicines you swallow. Almost none of the skin cream is absorbed into the body, so alcohol, sun exposure and your other prescriptions are not an issue.

Side Effects

Common and expected
  • Mild stinging or burning for a few minutes after applyingRedness or itching where it is used Dryness or peeling of the treated skin
  • These affect a small minority of people and usually settle within a few days.
Tell your doctor
  • Irritation that is getting worse rather than better after the first weekA rash that keeps spreading, especially one with a raised scaly edge and a clearer middle — that can mean a steroid has been used on it, or that the diagnosis is wrong No change at all after two weeks A fold that turns bright red, weepy or painful, which suggests bacteria as well as yeast
Stop and get care
  • Hives, swelling of the face or lips, or trouble breathingBlistering or peeling of the treated skin

How Long Until It Works

The first week

Itch and burning ease first, often within two or three days. This is the point at which most people wrongly decide it has worked.

Weeks one to two

Redness fades and the scaling settles. A ringworm patch on the body usually looks close to normal by now.

Weeks two to four

This is the part that actually clears the infection. Athlete's foot needs the full four weeks — the skin on the sole is thick and the fungus sits deeper in it.

If nothing has changed at two weeks

Either it is not fungus, or it needs something stronger. A rash that has not moved at all in two weeks is worth having looked at rather than treating for another month.

The marks afterwards

Where the rash was, skin can stay lighter or darker for weeks to months after the fungus has gone. This is far more noticeable on brown and Black skin. It is pigment change from the inflammation, not leftover infection, and more antifungal cream will not shift it.

What Happens When You Stop

If you finish the full course, most infections do not return on their own. You can pick the fungus up again, though, and feet are the usual route — athlete's foot comes back for a lot of people because the shoes were never treated.

If you stop early, it usually returns within a few weeks in the same place, and people then decide the cream failed. It did not. The course did.

Skin folds behave differently. Intertrigo comes back whenever the fold is warm and damp again, however well the yeast was treated. Keeping the fold dry is what prevents it; the cream only handles the flare.

There is no rebound and nothing to taper. You can stop the day the course ends.

FAQ+
How long does clotrimazole take to work?Itching eases in two or three days, and the rash looks better in one to two weeks. Clearing the infection takes two to four weeks, and you should keep applying for one to two weeks after the skin looks normal.
Is clotrimazole the same as Lotrimin?Lotrimin AF cream is clotrimazole. But Lotrimin AF powder and spray are usually miconazole, and Lotrimin Ultra is butenafine. Check the active ingredient on the box rather than the brand name.
Clotrimazole or terbinafine — which is better?For ringworm and athlete's foot, terbinafine is stronger and needs a much shorter course, usually one to two weeks instead of four. For a rash in a skin fold, clotrimazole is the better choice, because terbinafine barely touches Candida yeast and clotrimazole does.
Can I use it on my face?Yes, on fungal rashes, but avoid the eyes. If a facial rash is not clearly fungal it is worth having it looked at, because several common face rashes look similar and are treated in completely different ways.
Will it cure a fungal toenail?No. Cream cannot get through the nail plate. It is still worth using on the surrounding skin, because that skin is usually where reinfection of the nail comes from.
Can I use it in pregnancy?Topical clotrimazole is one of the better-studied options and very little of it is absorbed through the skin. Vaginal clotrimazole is a standard treatment for thrush in pregnancy.
Why does my rash keep coming back?Usually one of three things: the course was stopped when the itch went, the shoes or towels were never dealt with, or it is a skin fold that keeps getting damp again. Occasionally it is because the rash was never fungal.
Can I use hydrocortisone with it?Briefly, and only if a doctor has advised it. On its own, steroid makes fungal rashes spread and harder to identify.
Is there a stronger clotrimazole?Not for skin. 1% is the only strength. If it is not working, the answer is a different drug — terbinafine for ringworm, or a prescription cream — not a higher concentration.
Does the vaginal cream work on skin?It is the same drug and it will work, but it is greasier and more expensive per gram than the skin cream. There is no advantage to using it that way.