Medication

Econazole

Econazole is a prescription antifungal cream applied once a day. It covers fungus, yeast and some bacteria, which is why it is often chosen for soggy skin between the toes and in skin folds.
At a Glance

Econazole is a prescription azole antifungal cream. Like the over-the-counter azoles it treats both the ringworm family and Candida yeast, but it also has useful activity against some gram-positive bacteria — handy where skin is wet, broken and probably has more than one thing growing in it. Most courses are once a day, which is easier to keep up than twice-daily creams. It is no more powerful than clotrimazole against plain ringworm, and it costs considerably more.

Key Facts

Drug ClassTopical azole antifungal
Other NamesSpectazole, Ecoza (foam), econazole nitrate 1%
Prescription OnlyYes in the United States. In some countries it is sold over the counter.
Typical CourseOnce a day for 2 weeks for ringworm, jock itch or tinea versicolor; once a day for 4 weeks for athlete's foot; twice a day for 2 weeks for Candida in a fold
CostGeneric 1% cream is roughly $15 to $60 for a 30 g tube depending on pharmacy and insurance. The branded foam (Ecoza) is far more expensive and rarely worth the difference.

How It Works

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Econazole blocks the enzyme fungi need to make ergosterol, the fatty substance that holds their outer membrane together. The membrane becomes leaky and the fungus stops growing. This is the same route the other azoles use, so the coverage is similar: dermatophytes, Candida yeast, and Malassezia, the yeast behind tinea versicolor and seborrheic dermatitis.

What sets econazole apart in practice is a side activity against gram-positive bacteria such as staph and strep. Wet, macerated skin — between the toes, in the groin, under a breast — is rarely infected with one organism at a time. A cream that handles both is a reasonable single choice there, which is the main reason a dermatologist reaches for econazole rather than the cheaper drugstore option.

What It Treats

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Strong evidence
Econazole covers dermatophytes plus Gram-positive bacteria, making it a sensible single agent for macerated interdigital tinea pedis where bacterial overgrowth coexists.
Strong evidence
Econazole covers dermatophytes, yeast and some Gram-positive bacteria, which makes it useful in macerated or intertriginous sites where mixed infection is likely.
Moderate evidence
Econazole has antifungal activity plus modest gram-positive antibacterial activity, which is why it is favoured in mixed skin-fold infections.
Moderate evidence
Econazole is effective against Malassezia and is one of several interchangeable prescription azole creams for limited pityriasis versicolor.

Who It's For & Who It's Not

Who it's for

Athlete's foot of the soggy, white, split-skin kind between the toes.

Rashes in skin folds where yeast and bacteria are both plausible.

Ringworm, jock itch and tinea versicolor, if a once-daily cream suits you better than twice daily.

Anyone whose skin was irritated by clotrimazole or miconazole.

Who it's not for

Nail infections — it cannot get through the nail.

Scalp ringworm, which needs a tablet.

A first attempt at ordinary ringworm, where an over-the-counter cream costs a fraction as much and works as well.

Anyone with a known reaction to an azole antifungal.

Inside the mouth, eyes or vagina. It is for external skin only.

How to Take It

How much and how often
  • A thin layer once a day for ringworm, jock itch, athlete's foot or tinea versicolor. Twice a day if you are being treated for yeast in a fold. Rub it in until it disappears.
Cover past the edge
  • Spread it about an inch (two centimetres) beyond the visible border. For athlete's foot, treat the whole foot — sole, sides, heel and every space between the toes — even where the skin looks fine.
How long
  • Two weeks for most rashes, four weeks for athlete's foot. Then keep going one to two weeks past the point where the skin looks normal. Stopping at the point it looks better is the most common reason it comes back.

What to Avoid

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Steroid creams on the same rash unless a doctor has specifically told you to. Steroid on fungus takes the itch away and lets it spread.

Occlusive dressings or plastic wrap over it, unless advised — this drives more of it into the skin and increases irritation.

Eyes, mouth and vagina. External skin only.

Untreated shoes. If you are treating athlete's foot, powder or spray the insides of your shoes at the same time.

There are no meaningful interactions with tablets, alcohol or sunlight. Very little econazole is absorbed through intact skin, though slightly more gets through broken or macerated skin, which is another reason not to cover it up tightly.

Side Effects

Common and expected
  • Burning or stinging on application — more likely on broken or macerated skinItching or redness at the site Dryness or peeling
  • Roughly 3 in 100 people get enough local irritation to notice it.
Tell your doctor
  • Irritation that is getting worse after the first few days rather than betterNo improvement after two weeks Skin that becomes more painful, weepy, crusted or yellow, which suggests bacterial infection needing an oral antibiotic A new rash spreading beyond where you applied it, which can mean an allergy to the cream rather than the infection worsening
Stop and get care
  • Hives, swelling of the face or lips, or trouble breathingBlistering, or widespread peeling of treated skin

How Long Until It Works

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Days two to five

Itch and burning usually settle first. Soggy skin between the toes starts to dry and firm up.

Weeks one to two

Redness and scaling fade. Ringworm, jock itch and tinea versicolor generally look clear by the end of week two.

Weeks two to four

Athlete's foot needs the longer course. The thick, dry, scaly kind on the sole takes the whole four weeks and sometimes still needs a tablet.

No change after two weeks

Worth going back rather than continuing. Either the diagnosis is wrong, or the infection needs an oral antifungal.

Afterwards

Darker or lighter patches can remain for weeks to months where the rash was, and are more visible on brown and Black skin. This is pigment change from inflammation, not infection, and it fades on its own.

What Happens When You Stop

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You stop at the end of the course. There is no taper and nothing rebounds.

If the course was completed properly, ringworm and jock itch normally stay away. Athlete's foot is the one that returns, because shoes stay warm and damp and hold fungus. Treating the footwear and drying between the toes matters as much as the cream for keeping it away.

In a skin fold, the rash comes back whenever the fold is wet again. Econazole clears the flare; keeping the skin dry and separated is what prevents the next one.

Tinea versicolor also tends to return, most often in the next warm season. That is normal and does not mean the cream failed.

FAQ+
Why would I be given econazole instead of an over-the-counter cream?Usually because the skin is wet and broken and bacteria are likely alongside the fungus, or because you have already tried an over-the-counter cream. It is also once a day rather than twice, which people stick to better.
Is econazole stronger than clotrimazole?Not against ordinary ringworm — they are similar. Its advantages are the once-daily dosing and the extra activity against bacteria.
How long until the itching stops?Usually within a few days. That is not the point to stop applying it.
Can I use it on my face?Yes, on a fungal rash, keeping it away from the eyes. Facial rashes are easy to misidentify, so it is worth being sure it is fungal first.
Will it treat a fungal nail?No. It cannot penetrate the nail plate. It is still useful on the skin around the nail, which is where reinfection usually starts.
Can I use it in pregnancy?Very little is absorbed through intact skin. Discuss it with your doctor, particularly if you would be treating a large or broken area, where more gets through.
Does it treat jock itch?Yes, once a day for two weeks. Treat your feet at the same time — jock itch is very often carried up from athlete's foot on a towel or a pair of underwear pulled on after socks.
What if the skin between my toes still smells?Smell usually means bacteria. Econazole covers some of them, but a foul smell with sore, eroded skin often needs an oral antibiotic as well, so it is worth being seen.