In the past 40 years imidazoles have been used extensively in medicine for their antifungal properties. All members of the azole antifungal family inhibit ergosterol biosynthesis. However, the discovery of an additional fungicidal mode of action for miconazole has drawn renewed attention to this compound. In this article we review recent evidence of mechanistic efficacy, as well as clinical trial results of miconazole in new topical formulations.