Usage
This combination medication is prescribed for inflammatory skin conditions with secondary bacterial and/or fungal infections. It is effective against a range of dermatological issues, including:
- Dermatitis with secondary infection
- Tinea infections (ringworm, athlete’s foot, jock itch) with an inflammatory component
- Candidiasis (skin yeast infections) with an inflammatory component
- Insect bites and stings with secondary infection
Pharmacological Classification:
This is a combination product containing drugs from different classifications:
- Beclometasone: Corticosteroid (topical)
- Chlorocresol: Antiseptic and preservative
- Clotrimazole: Antifungal (imidazole derivative)
- Neomycin: Aminoglycoside antibiotic
Mechanism of Action:
- Beclometasone: Reduces inflammation and itching by suppressing the immune response and inhibiting the production of inflammatory mediators like prostaglandins.
- Chlorocresol: Acts as a preservative in the cream formulation and has antiseptic properties, preventing bacterial contamination of the product.
- Clotrimazole: Inhibits the synthesis of ergosterol, a vital component of fungal cell membranes. This disruption leads to fungal cell death.
- Neomycin: Inhibits bacterial protein synthesis, leading to bacterial cell death. It is effective against many gram-positive and gram-negative bacteria.
Alternate Names
This combination medication is often referred to by different brand names depending on the manufacturer and region. Some possible brand names or variations include:
- QD More Cream
- Neonate Cream/Ointment
- B.N. Clot Ointment
- Mexaclo N Cream
- Kunis Cream
- Turboderm Cream
How It Works
Pharmacodynamics:
The combination exerts a synergistic effect by addressing the infection and inflammation simultaneously. Beclometasone reduces inflammation, while clotrimazole and neomycin target the fungal and bacterial components of the infection, respectively. Chlorocresol prevents further contamination.
Pharmacokinetics:
- Absorption: Topical application results in minimal systemic absorption of the active ingredients under normal skin conditions. Increased absorption may occur with prolonged use, application to large areas, or if the skin barrier is compromised.
- Metabolism: Beclometasone and clotrimazole are primarily metabolized in the liver.
- Elimination: Neomycin is mainly excreted unchanged in the urine. Clotrimazole metabolites are excreted in bile and urine.
Mode of Action:
- Beclometasone binds to glucocorticoid receptors, reducing inflammatory mediator production.
- Neomycin interferes with bacterial ribosomal function, inhibiting protein synthesis.
- Clotrimazole alters fungal cell membrane permeability, causing leakage and cell death.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected skin area twice daily (morning and evening) or as directed by the physician. Do not exceed 45 grams of cream per week unless under direct medical supervision. Treatment duration typically ranges from 2 weeks (tinea cruris, tinea corporis, candidiasis) to 4 weeks (tinea pedis).
Children:
Use in children under 12 years of age is generally not recommended unless specifically directed by a physician. Pediatric dosage should be determined by a doctor based on the child’s age, weight, and the specific condition being treated. Some sources suggest it is not recommended for children under 17.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required. Close monitoring for adverse effects is advisable.
- Patients with Renal Impairment: Caution is advised due to the potential for neomycin absorption, particularly with extensive application or damaged skin. Monitor renal function, especially in cases of prolonged use or significant skin damage.
- Patients with Hepatic Dysfunction: Caution is advised. Monitor for systemic side effects.
- Patients with Comorbid Conditions: Consider individual patient factors and potential drug interactions.
Clinical Use Cases
This combination is generally not indicated for systemic or internal use. It is intended for topical application on the skin only. Therefore, dosages relevant to intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations do not apply to this medication.
Dosage Adjustments
Dosage adjustments may be necessary based on the severity of the skin condition, patient’s response to treatment, presence of renal or hepatic impairment, and coexisting medical conditions. Always consider individual patient factors.
Side Effects
Common Side Effects:
- Itching
- Burning sensation
- Skin irritation
- Redness (erythema)
- Dryness
- Stinging
Rare but Serious Side Effects:
- Skin atrophy (thinning)
- Telangiectasia (spider veins)
- Hypopigmentation (skin lightening)
- Hypertrichosis (increased hair growth)
- Perioral dermatitis (rash around the mouth)
- Allergic contact dermatitis
- Secondary infections
Long-Term Effects:
Prolonged use of topical corticosteroids can lead to skin atrophy, striae (stretch marks), telangiectasia, and an increased risk of skin infections.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis) to neomycin are rare but can occur.
Contraindications
- Hypersensitivity to any of the components (beclometasone, neomycin, clotrimazole, chlorocresol)
- Viral skin infections (herpes simplex, varicella zoster, chickenpox)
- Tuberculous or syphilitic skin lesions
- Rosacea
- Acne
- Perioral dermatitis
- Vaccinia
Drug Interactions
- Systemic corticosteroids: Concurrent use may increase the risk of systemic adverse effects.
- Immunosuppressants: Concomitant use may increase the risk of infections.
- Other topical medications: Avoid using other topical medications on the same area unless advised by a doctor.
- Polyene antibiotics: (e.g., filipin, amphotericin B, nystatin, and natamycin) - Interactions may occur.
Pregnancy and Breastfeeding
The safety of this combination during pregnancy and breastfeeding has not been definitively established. Use only if clearly needed and under the supervision of a physician. Potential risks to the fetus or nursing infant should be weighed against the potential benefits to the mother.
Drug Profile Summary
- Mechanism of Action: Combines anti-inflammatory, antibacterial, and antifungal actions.
- Side Effects: Itching, burning, irritation, redness, dryness. Rarely: skin atrophy, telangiectasia, hypopigmentation, allergic reactions.
- Contraindications: Hypersensitivity, viral infections, rosacea, acne.
- Drug Interactions: Systemic corticosteroids, immunosuppressants, polyene antibiotics.
- Pregnancy & Breastfeeding: Use with caution if clearly needed. Consult physician.
- Dosage: Topical, thin layer twice daily.
- Monitoring Parameters: Monitor skin for signs of adverse effects, especially with prolonged use. Renal and liver function tests may be advisable in certain cases.
Popular Combinations
This specific combination is itself widely used. There may be regional variations with different brand names.
Precautions
- General Precautions: Avoid contact with eyes, mucous membranes, and open wounds. Do not use occlusive dressings unless directed by a physician.
- Specific Populations: Use with caution during pregnancy and breastfeeding. Not recommended for children under 12 (or 17, according to some sources).
- Lifestyle Considerations: Avoid excessive sun exposure, as it may exacerbate skin irritation.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area twice daily. Do not exceed 45g per week unless under medical supervision. Consult a physician for pediatric dosing.
Q2: Can this combination be used for all types of skin infections?
A: No. It is not effective against viral skin infections (like chickenpox, shingles, or herpes), or infections caused by mycobacteria or systemic fungi. It should also not be used for acne or rosacea.
Q3: What should I do if I accidentally swallow the cream?
A: Seek immediate medical attention, as ingestion can be harmful.
Q4: Can I use this cream on my face?
A: Use on the face only under medical supervision, as facial skin is more sensitive.
Q5: Can I use this cream during pregnancy or while breastfeeding?
A: Consult your doctor before using this medication during pregnancy or breastfeeding. The safety profile in these situations is not fully established.
Q6: What should I do if my symptoms don’t improve after using the cream?
A: Consult your doctor if there is no improvement after the recommended treatment period, as a different medication or approach may be needed.
Q7: Are there any drug interactions I should be aware of?
A: Inform your doctor about all other medications you are taking, including topical products, oral medications, and supplements, as interactions may occur. Specific interactions can occur with systemic corticosteroids and immunosuppressants.
Q8: What are the potential long-term effects of using this cream?
A: Prolonged use of topical corticosteroids, like beclometasone, can lead to skin thinning (atrophy), stretch marks (striae), telangiectasia (spider veins), and an increased susceptibility to skin infections.
Q9: Can I stop using the cream once my symptoms improve?
A: No, complete the full course of treatment prescribed by your doctor, even if symptoms resolve earlier. This ensures complete eradication of the infection and prevents recurrence.
