Understanding Nystatin Cream and Its Uses

Nystatin is an affordable antifungal treatment that has been around for almost 70 years. It was once one of the most widely used medications for treating oral Candida infections (a genus of yeast). Although it is no longer as popular due to newer antifungal medications, it still has its place. Its primary use is to treat Candida infections of the mouth, esophagus, intestine and skin.

Nystatin is only available via prescription from your medical provider. It comes in cream, tablet, and suspension (liquid). The suspension has a bitter taste, so it has been shown that patients may be less likely to take it regularly compared to other treatment options. In general, it is considered a safe medication and is well tolerated. Understanding how it works, its uses in treating Candida infections, and potential side effects is beneficial when struggling with this fungal infection.

THE BASICS OF NYSTATIN 

Nystatin is part of a group of antifungals known as polyenes. It is effective against yeast infections belonging to the genus Candida. It’s important to note that yeast is a fungus, so when an antifungal medication is used to treat a yeast infection, it is understood why. 

Nystatin works by binding to Candida’s membrane sterols (primarily ergosterol). It changes the membrane permeability, resulting in a hole that allows all the essential intracellular components to leak out. This leads to cellular death. Think of it like a water balloon with a pinhole leak. 

NYSTATIN TODAY

Since the 1950s, Nystatin has been widely used to treat various fungal infections caused by Candida species. Although Nystatin’s use has waned due to newer antifungal treatments, it does have its place. 

According to eMedicine…“Resistance to Nystatin is rare, although the drug's contact killing makes it somewhat more difficult to use because it must be applied to all of the affected mucosal surfaces to be effective (unlike systemic therapies). Failures with nystatin are more common…”

That said, Nystatin still remains an effective treatment option for oral candidiasis and in situations where other antifungals are not appropriate (such as allergy). Also, it is usually readily available when traveling abroad to countries where healthcare options/medications may be more challenging to obtain. 

CANDIDA IS A NORMAL PART OF OUR BODY’S BIOME…UNTIL IT’S NOT!

Candida is a normal part of our body’s biome which usually causes no problem. It typically resides on the skin, mouth, digestive tract and vagina. It is considered the most common member of the gut biome. The challenge begins when overgrowth occurs, resulting in a fungal infection. Let’s focus on skin conditions caused by yeast overgrowth…

Cutaneous Candidiasis (skin)

Cutaneous candidiasis can occur anywhere on the body where it’s warm and moist. Under the breasts, armpits, folds of skin, groin, even between toes and sometimes fingers. It typically presents as intense patches of redness with tiny bumps along the edges. Predisposing factors include but are not limited to:

• Diabetes 
• Hot or humid weather
• Overweight with folds of skin
• Lack of consistent hygiene
• Diapers, constrictive clothing
• Weakened immune system
• Medications: antibiotics, birth control pills, oral steroids
• Age extremes: young (i.e. baby) or elderly

Vulvovaginal Candidiasis (yeast infection)

According to the CDC…”An estimated 75% of women will have at least one episode of VVC (vulvovaginal candidiasis), and 40%--45% will have two or more episodes within their lifetime.” Some of the main symptoms in women are moderate to severe itching of the vaginal area, redness and swelling in the genital area, white or red patches/plaques, thick “cottage cheese” like discharge from the vagina, and discomfort during sex and/or urination. 

NOTE: These symptoms are similar to other infections/disease processes such as STIs, eczema, contact dermatitis, etc. Dermatologists can get referrals for patients who do not respond to traditional treatment. It’s important to speak with a medical provider should you develop symptoms. Predisposing factors include but are not limited to:

• Pregnancy
• Diabetes 
• Weakened immune system
• Medications: antibiotics, birth control pills, oral steroids
• Use of some douches, vaginal sprays, lubricants, or spermicides
• Wearing a wet bathing suit and/or sweaty underwear for extended periods
• Lack of consistent hygiene
• A diet high in sugar and carbohydrates

Oropharyngeal Candidiasis (Thrush)

‍Oropharyngeal Candidiasis, also known as Thrush) is a yeast infection of the mouth and throat. Dermatology medical providers usually do not treat this condition. 

• Diabetes
• Weakened immune system
• Disruption in the microbiome
• Poor oral hygiene, dentures, mouth appliances
• Tobacco and alcohol use
• A diet high in sugar and carbohydrates
• Consistently dry mouth (usually a side effect from a medication)
• Medications: antibiotics, birth control pills, oral steroids
• Age extremes: young (i.e. baby) or old

Gastrointestinal Candidiasis (GI tract)

Fungal infection of the GI tract may occur when there is an imbalance of normal bacteria to Candida Albicans, leading to an overgrowth. Dermatology medical providers do not treat this condition. 

When using Nystatin, it is crucial to follow the instructions provided by your healthcare provider. The recommended dosage may vary depending on the severity of the infection and the individual's specific circumstances. 

COMMON SIDE EFFECTS OF NYSTATIN

Although Nystatin is generally well-tolerated (besides the unpleasant bitter taste from the suspension) side effects may still occur. These include:

• diarrhea
• nausea
• stomach bloating or pain
• skin irritation including inside the mouth
• allergic reaction

SERIOUS SIDE EFFECTS AND WHEN TO SEEK MEDICAL ATTENTION

While serious side effects from Nystatin are rare, they can occur. This includes an allergic reaction. Symptoms may include a skin rash, itching, hives, swelling of the face, lips, tongue, or throat, and trouble breathing. If you experience any of these symptoms, it is crucial to stop use and immediately seek medical attention. Your healthcare provider will be able to determine the appropriate course of action based on your individual circumstances.

In conclusion, although Nystatin is not as widely used as it used to be, it still remains an effective antifungal medication. 

If you have a rash that will not go away, please contact our Dermatology team online at Piction Health. We can help!

NYSTATIN FAQs

Q: How does Nystatin work?

A: Nystatin works by binding to Candida’s membrane sterols (primarily ergosterol). It changes the membrane permeability, resulting in a hole that allows all the essential intracellular components to leak out. This leads to cellular death. Think of it like a water balloon with a pinhole leak. 

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Q: What are some of the benefits of Nystatin cream compared to other antifungal treatments?

A: It’s affordable and treats a range of Candida infections (a genus of yeast). 

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Q: Where does Cutaneous candidiasis (skin) most likely occur?

A: Under the breasts, armpits, folds of skin, groin, even between toes and sometimes fingers. 

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Q: Is Vulvovaginal candidiasis an STI?

A: No. Vulvovaginal candidiasis yeast infections aren’t sexually transmitted infections(STIs) although they can be passed to a partner during sex, but it’s rare.

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Q: Is Candida a normal part of our bodies?

A: Yes, Candida is a normal part of our skin and gastrointestinal biome. 

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PICTION HEALTH VIRTUAL DERMATOLOGY

For convenient access to professional dermatology care, visit Piction Health's online dermatology platform. Our board-certified dermatologists are ready to provide personalized guidance for your dermatology concerns. Take the first step towards healthier, happier skin by scheduling an online dermatology consultation today.

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RESOURCES

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441600/
• https://emedicine.medscape.com/article/781215-treatment
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441600/
• https://emedicine.medscape.com/article/969147-medication
• https://read.qxmd.com/read/27042008/efficacy-of-nystatin-for-the-treatment-of-oral-candidiasis-a-systematic-review-and-meta-analysis?redirected=slug
• https://quadram.ac.uk/blogs/what-fungi-live-in-the-gut-meet-the-gut-mycobiome/#:~:text=There%20are%20some%20fungi%20that,people%20in%20the%20Western%20World.
• https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm
• https://www.nhs.uk/medicines/nystatin/who-can-and-cannot-take-or-use-nystatin/#:~:text=have%20ever%20had%20an%20allergic,use%20the%20cream%20or%20ointment

DISCLAIMER

The information provided on this medical blog is for educational and informational purposes only and is not intended as medical advice. While we strive for accuracy, medical knowledge constantly evolves, and individual health situations vary. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this blog. The authors and publishers of this blog are not responsible for any adverse effects or consequences resulting from using any suggestions, products, or procedures discussed in this blog.

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