## 7 The Use of Ciclopirox in Specific Formulations  
As it was previously said, ciclopirox olamine is a medication with a broad-spectrum antifungal activity, widely utilized in the management of various fungal infections. Its therapeutic safety and efficacy have been repeatedly confirmed in a multitude of studies [5; 36]. One of the primary applications of ciclopirox olamine is in dermatology [5]. Therefore, it is offered in various topical formulations designed for application to the skin, nails, and vaginal area. The most extensively studied pharmaceutical forms include cream and nail lacquer; however, other formulations such as lotions, sprays, shampoos, pessaries, solutions, gels, and douches have also been utilized. Ciclopirox demonstrates the ability to penetrate deep into the skin layers, mucosal membranes, and nail keratin, achieving concentrations that surpass the minimum fungicidal concentrations required to inhibit most clinically significant fungi [5]. \begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt}} \hline \hline
**Mechanism** & **Description** \\ \hline Enzyme inhibition & Inhibits metal-dependent enzymes (e.g., cytochromes, catalase), disrupting mitochondrial function. \\ \hline Iron metabolism alteration & Regulates iron transport genes, creating iron-limiting conditions. \\ \hline Mitochondrial dysfunction & Disrupts electron transport, cytochrome function, and energy production. \\ \hline Anti-inflammatory action & Inhibits free radicals, cyclooxygenase, 5-lipoxygenase, and pro-inflammatory cytokines. \\ \hline Synergistic effects & Enhances activity of other chelators and inhibitors, reducing resistance risk. \\ \hline \hline \end{tabular}
\end{table} 
Table 2: _Cont._For example, a 1% ciclopirox olamine cream is often employed in the treatment of skin mycoses, where it has been shown to inhibit and kill 93% and 98% of fungal pathogens, respectively, in a pig skin model. These results are considerably more effective than those of other topical antifungal agents, which typically demonstrate less than 50% effectiveness [37]. Both the lotion and gel formulations have similar efficacy and dosing regimens, with the gel reportedly acting faster [5]. One of the primary uses of ciclopirox is in treating scalp conditions, such as dandruff and seborrheic dermatitis, through anti-dandruff shampoos where it serves as the active ingredient. Clinical studies have confirmed the significant efficacy of ciclopirox-based shampoos in both the treatment and prevention of these conditions. Its broad-spectrum antimicrobial activity, especially against _Malassezia_ yeasts, and anti-inflammatory properties are thought to contribute to its effectiveness [5; 18; 38]. The studies evaluated the in vitro susceptibility of _Malassezia furfur_, revealing minimum inhibitory concentration (MIC) values between 0.001 and 0.125 ug/mL. The demonstrated effectiveness of ciclopirox against _Malassezia_ has supported its successful application in the treatment of seborrheic dermatitis. For this reason, ciclopirox olamine is also incorporated into gel-based formulations, such as shampoos, to treat various forms of dermatitis, including dandruff. Clinical trials have shown that a 1% ciclopirox shampoo, available in the EU and the US for the treatment of seborrheic dermatitis, can significantly improve scalp conditions and alleviate symptoms compared to a placebo. It is recommended for application twice weekly for 4 weeks [5; 18]. At the conclusion of the treatment period, assessments were conducted to evaluate erythema, scaling, and pruritus, along with an overall clinical evaluation. By the fourth week, a significantly higher proportion of patients in the ciclopirox-treated group showed complete resolution or notable improvement in symptoms compared to those in the placebo group [39].