Mikanisal (Ketoconazole)

Ketoconazole is applied topically to manage fungal skin conditions by inhibiting the growth of dermatophytes and yeasts.

• Tinea corporis: reduces fungal proliferation and promotes clearance of ring‑shaped lesions.
• Tinea cruris: alleviates itching and erythema in the groin area caused by fungal infection.
• Tinea pedis: treats athlete’s foot, diminishing scaling and discomfort.
• Seborrheic dermatitis: controls Malassezia‑related inflammation on scalp and face.
• Other superficial fungal skin infections: effective against a range of dermatophyte and yeast infections on the skin.

• Ketoconazole inhibits the fungal enzyme lanosterol 14α‑demethylase, a key step in ergosterol synthesis. By blocking ergosterol production, the drug disrupts the integrity of the fungal cell membrane, leading to increased permeability and ultimately cell death, thereby eliminating the infection at the site of application.

Topical ketoconazole may cause local and systemic reactions, most of which are mild.

Common Side Effects

• Skin irritation: mild redness or itching at the application site.
• Burning sensation: transient warmth or stinging after application.
• Dryness: mild peeling or flaking of treated skin.
• Pruritus: occasional itching unrelated to infection.

Serious or Rare Side Effects

• Allergic contact dermatitis: widespread rash, swelling, or hives requiring medical attention.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis, extremely rare but serious.
• Systemic absorption effects: hepatotoxicity or hormonal disturbances reported rarely with extensive use.

Before using Mikanisal, consider the following safety measures.

• Pregnancy: consult a healthcare provider before use, as safety data are limited.
• Breastfeeding: evaluate risk‑benefit, ketoconazole may be excreted in milk.
• Extensive body surface area: limit application to avoid significant systemic absorption.
• Concomitant liver disease: monitor liver function if large areas are treated.
• Store at below 25°C: keep in the original container, protect from moisture and direct sunlight.

Ketoconazole can interact with other medicines; some combinations require avoidance while others need monitoring.

Major Interactions (Avoid)

• Systemic azoles (e.g., itraconazole, fluconazole): combined use may increase risk of hepatotoxicity.
• Topical corticosteroids: may mask infection signs, reducing treatment effectiveness.
• Warfarin: ketoconazole can potentiate anticoagulant effect if absorbed systemically.

Moderate Interactions (Monitor Closely)

• Oral antihistamines: may increase sedation if systemic absorption occurs.
• Other topical antifungals: concurrent use may increase local irritation.
• Photosensitizing agents: advise sun protection as skin may be more sensitive.