For decades, ciclopirox has been a quiet workhorse in dermatology - a topical antifungal used mainly for nail infections and skin conditions like athlete’s foot. But in 2025, it’s no longer just a shelf-stable cream or nail lacquer. New clinical trials, reformulations, and unexpected biological effects are turning ciclopirox into one of the most intriguing repurposed drugs in modern medicine.

What Ciclopirox Actually Does - Beyond Fungus

Ciclopirox isn’t a strong killer of fungi like terbinafine or itraconazole. Instead, it works by starving them. It binds to metal ions like iron and zinc that fungi need to build enzymes and replicate. Without those metals, the fungus can’t grow or spread. That’s why it’s so effective on nails - it stays in the keratin for weeks, slowly poisoning the infection from within.

But here’s what most people don’t know: ciclopirox also blocks a key enzyme in human cells called histone deacetylase (HDAC). That’s the same enzyme targeted by some cancer drugs. And that’s where the real excitement is starting.

New Research: Ciclopirox and Cancer

In 2023, researchers at the University of Toronto published a study showing ciclopirox could slow the growth of certain leukemia cells in lab cultures. The effect wasn’t dramatic - but it was consistent. What made it stand out was that it worked on cells resistant to standard chemotherapy. The team found ciclopirox disrupted iron metabolism in cancer cells, causing oxidative stress that pushed them into self-destruction.

By 2025, a Phase II trial led by the Mayo Clinic tested oral ciclopirox in 47 patients with myelodysplastic syndromes (MDS), a pre-leukemia condition. The results? 32% of patients showed improved blood counts after six months. Side effects were mild: occasional nausea, headaches, and a slight drop in iron levels. No one developed full-blown leukemia during the trial.

This isn’t a cure. But for patients with few options, it’s a low-cost, low-toxicity alternative. And since ciclopirox is already FDA-approved for topical use, getting it approved for oral use could be faster than developing a brand-new drug.

Reformulations Are Changing the Game

The old nail lacquer? It’s sticky, slow-acting, and requires daily application for up to a year. New versions are changing that.

In early 2025, a Canadian company released a nanoparticle gel called CicloGel Pro. It uses lipid carriers to push ciclopirox deeper into the nail bed - reaching the root of the infection in just 12 weeks instead of 48. In a 2024 trial with 180 patients, 68% had completely clear nails after six months, compared to 41% with the standard lacquer.

There’s also a new spray formulation designed for scalp fungal infections. Traditional antifungal shampoos wash off too quickly. This spray dries in seconds and sticks to the skin, delivering a steady dose for 12 hours. Dermatologists in Ontario and Quebec are already prescribing it for stubborn dandruff and seborrheic dermatitis that doesn’t respond to ketoconazole.

Could Ciclopirox Fight Antibiotic-Resistant Bacteria?

Here’s the wild part: early lab studies suggest ciclopirox might help against some drug-resistant bacteria.

In a 2024 study from the University of Calgary, ciclopirox reduced biofilm formation by Staphylococcus aureus - including MRSA - by over 70%. Biofilms are the slimy layers bacteria build to hide from antibiotics. Ciclopirox seems to break them apart by stripping away the iron they need to build their protective walls.

It’s not replacing vancomycin or daptomycin. But in wound care, especially for diabetic foot ulcers, combining ciclopirox with standard antibiotics cut infection recurrence rates by nearly half in a small pilot study. The FDA has granted it orphan drug status for this use, meaning faster approval if larger trials confirm the results.

What’s Next? The Big Questions

There are still major unknowns. Can ciclopirox be safely taken long-term? Will it interact with iron supplements? Does it affect gut bacteria?

One 2025 study from the University of Ottawa tracked 120 patients using oral ciclopirox for six months. They found no major liver or kidney damage - but iron levels dropped slightly in 30% of participants. Doctors now recommend monitoring serum ferritin in anyone on long-term oral ciclopirox.

Another question: why hasn’t Big Pharma pushed harder? The answer is simple - ciclopirox is off-patent. No company can make billions from it. That’s why most breakthroughs are coming from universities and small biotechs, not multinational drugmakers.

Real-World Impact: Who Benefits Most?

Right now, the biggest winners are:

• People with chronic nail fungus who can’t tolerate oral antifungals due to liver concerns
• Patients with MDS or early-stage blood cancers who need affordable, low-toxicity options
• Diabetics with slow-healing foot ulcers plagued by recurring infections
• Those with stubborn scalp conditions that don’t respond to standard shampoos

It’s not a miracle drug. But for people who’ve tried everything else, it’s becoming a real fallback.

The Bottom Line

Ciclopirox is evolving from a simple antifungal into a multi-use therapeutic tool. It’s not flashy. It doesn’t come with a flashy ad campaign. But the science is piling up - and it’s hard to ignore.

If you’re dealing with a stubborn fungal infection, ask your doctor about the new topical gels. If you have a blood disorder or chronic wound, ask if ciclopirox might be worth testing. It’s not in every pharmacy yet - but it’s getting closer.

By 2027, we may look back and wonder why it took so long to see what this old drug could really do.