Usage
This combination medication is prescribed for inflammatory skin conditions complicated by bacterial and/or fungal infections. These conditions may include:
- Infected eczema and dermatitis
- Impetigo
- Infected psoriasis
- Intertrigo (inflammation of skin folds)
- Infected lichen planus
- Scabies with secondary infection
- Otitis externa
- Diaper rash
- Lichen simplex chronicus
- Insect bites
- Minor burns and infected wounds
Pharmacological Classification: This is a combination product containing a corticosteroid (Beclometasone), an antifungal (Clotrimazole), an antibiotic (Gentamicin), and an antibacterial/antifungal agent (Clioquinol).
Mechanism of Action: This combination provides broad-spectrum antimicrobial and anti-inflammatory action. Beclometasone reduces inflammation and itching, Clotrimazole inhibits fungal growth, Gentamicin kills bacteria, and Clioquinol has both antibacterial and antifungal effects.
Alternate Names
No widely recognized alternate names exist for this specific four-drug combination, although the individual components have various synonyms.
Brand Names: Derminol, Clonem G (and others, depending on the region and manufacturer).
How It Works
Pharmacodynamics: Beclometasone exerts its anti-inflammatory effect by binding to glucocorticoid receptors, which modulate gene transcription and decrease the production of inflammatory mediators. Clotrimazole inhibits ergosterol synthesis, a crucial component of fungal cell membranes, leading to fungal cell death. Gentamicin inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Clioquinol disrupts bacterial and fungal cell membranes.
Pharmacokinetics: Primarily topical application. Systemic absorption is minimal under normal use but can increase with prolonged use, application to large areas, or damaged skin. Beclometasone is metabolized in the liver; Gentamicin is primarily excreted unchanged by the kidneys; Clotrimazole is metabolized in the liver; Clioquinol is partially metabolized and excreted in urine and feces.
Mode of Action: See Pharmacodynamics.
Receptor Binding/Enzyme Inhibition: Beclometasone binds to glucocorticoid receptors. Clotrimazole inhibits the enzyme 14-alpha-demethylase, crucial for ergosterol synthesis. Gentamicin binds to the 30S ribosomal subunit.
Elimination Pathways: See Pharmacokinetics.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected area once or twice daily.
Children: Use with caution and under the guidance of a physician. Dosage depends on age, weight, and the specific condition being treated.
Special Cases:
- Elderly Patients: Similar to adult dosing, with careful monitoring for adverse effects.
- Patients with Renal Impairment: Gentamicin component requires careful monitoring and potential dose adjustment in patients with renal dysfunction.
- Patients with Hepatic Dysfunction: Beclometasone and Clotrimazole are metabolized in the liver. Use with caution in hepatic impairment and monitor for adverse effects.
- Patients with Comorbid Conditions: Caution in patients with diabetes, hypertension, or other systemic diseases due to the potential for increased systemic absorption of Beclometasone.
Clinical Use Cases
This topical medication is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU care. For emergency situations, this topical medication is not generally appropriate.
Dosage Adjustments: Adjustments based on patient response, tolerance, and severity of the infection. Renal and hepatic impairment may require dose modification, especially for the Gentamicin component.
Side Effects
Common Side Effects:
- Burning or stinging at the application site
- Itching, irritation, redness, and dryness of the skin
- Folliculitis
- Hypopigmentation (skin lightening)
Rare but Serious Side Effects:
- Allergic reactions (rash, hives, swelling, difficulty breathing)
- Skin atrophy, striae, telangiectasia
- Adrenal suppression (with prolonged or extensive use)
- Cushing’s syndrome (with prolonged or extensive use)
Long-Term Effects: Skin atrophy, striae, telangiectasia, hypopigmentation.
Contraindications
- Hypersensitivity to any component
- Viral skin infections (herpes simplex, varicella, vaccinia)
- Tuberculosis or syphilitic skin lesions
- Rosacea, acne, perioral dermatitis
- Untreated fungal infections not susceptible to Clotrimazole
Drug Interactions
- Oral corticosteroids
- NSAIDs
- Oral hypoglycemics
- Coumarin anticoagulants
- Other azole antifungals
- Some antibiotics (penicillins, cephalosporins)
- Cyclosporine, cisplatin, neuromuscular blocking agents
Pregnancy and Breastfeeding
Use with caution and only if clearly needed, under strict medical supervision. Safety during pregnancy and breastfeeding is not fully established. Potential fetal or neonatal risks should be weighed against the benefits of treatment.
Drug Profile Summary
- Mechanism of Action: Combination of corticosteroid, antifungal, antibiotic, and antibacterial/antifungal agent.
- Side Effects: Burning, itching, irritation, dryness, folliculitis, hypopigmentation, skin atrophy, allergic reactions, adrenal suppression (with prolonged use).
- Contraindications: Hypersensitivity, viral skin infections, tuberculosis/syphilitic lesions, rosacea/acne/perioral dermatitis.
- Drug Interactions: Numerous interactions with systemic medications, including corticosteroids, NSAIDs, antifungals, and antibiotics.
- Pregnancy & Breastfeeding: Use with caution under medical supervision.
- Dosage: Topical application once or twice daily.
- Monitoring Parameters: Monitor for local and systemic side effects. With prolonged use, monitor for signs of skin atrophy, adrenal suppression, and Cushing’s syndrome.
Popular Combinations
This medication itself is a combination product. Additional combinations are not typically recommended.
Precautions
- Avoid contact with eyes, nose, and mouth.
- Do not use on open wounds, broken, or damaged skin.
- Avoid prolonged use or application to large areas, especially in children, due to the risk of systemic absorption.
- Monitor patients with renal impairment or hepatic dysfunction.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area once or twice daily. Pediatric dosing should be determined by a physician.
Q2: Can this cream be used on the face?
A: Use on the face with caution and only under a doctor’s guidance. Avoid the area around the eyes.
Q3: What should I do if I miss a dose?
A: Apply the missed dose as soon as remembered, unless it is almost time for the next dose. Do not apply a double dose.
Q4: Can this cream be used during pregnancy or breastfeeding?
A: Use with caution during pregnancy and breastfeeding and only under strict medical supervision. Discuss the potential risks and benefits with your doctor.
Q5: How long does it take to see improvement?
A: It may take several days to weeks to see improvement. Complete the full course of treatment as prescribed, even if symptoms improve earlier.
Q6: Can this cream be used for acne or rosacea?
A: No, this cream is not appropriate for acne or rosacea and may worsen these conditions.
Q7: What are the signs of an allergic reaction?
A: Signs of an allergic reaction include rash, hives, itching, swelling (especially of the face, tongue, or throat), and difficulty breathing. Seek immediate medical attention if these occur.
Q8: What should I do if my condition worsens or doesn’t improve after several weeks?
A: Consult your doctor. They may need to adjust the treatment or investigate alternative diagnoses.
Q9: Can I use this cream on open wounds?
A: No, avoid applying this cream to open wounds or broken skin.
Q10: What are the potential long-term side effects of this cream?
A: Long-term use can lead to skin thinning, stretch marks, changes in skin pigmentation, and increased susceptibility to skin infections.
