Usage
This topical medication is primarily prescribed for inflammatory skin conditions like psoriasis, eczema, and dermatitis. It is also used to treat ringworm, warts, corns, and acne. It can be classified as a keratolytic, anti-inflammatory, and antifungal agent.
The mechanism of action involves the synergistic effects of its components. Salicylic acid promotes exfoliation of the stratum corneum (outermost skin layer) by breaking down keratin, thereby removing scales and softening the skin. Hydrocortisone, a corticosteroid, provides anti-inflammatory action by suppressing the immune response and reducing redness, itching, and swelling. Benzoic acid acts as an antiseptic and antifungal agent, inhibiting microbial growth.
Alternate Names
While no official alternate names exist, it is often referred to as a combination of its individual components. Brand names under which it is marketed include “Keralin Ointment” and “Whitolyn DS Ointment”.
How It Works
Pharmacodynamics: The combined action of benzoic acid, hydrocortisone, and salicylic acid leads to a reduction in inflammation, scaling, and microbial growth on the skin. Salicylic acid increases skin cell turnover and loosens the connections between corneocytes (skin cells), resulting in exfoliation. Hydrocortisone reduces inflammation by inhibiting the release of inflammatory mediators. Benzoic acid hinders the growth of fungi and some bacteria.
Pharmacokinetics: The medication is applied topically, and the extent of systemic absorption depends on factors like the concentration applied, the area of application, and the integrity of the skin barrier. Generally, systemic absorption is minimal. Salicylic acid is metabolized in the liver and excreted by the kidneys. Hydrocortisone, when absorbed systemically, is metabolized in the liver and excreted primarily in urine. Benzoic acid is conjugated with glycine in the liver and excreted in the urine as hippuric acid.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected skin area twice daily.
Children: Use with caution in children older than two years. Consult a pediatrician for appropriate dosage based on the child’s age and condition. Use is not recommended for children under two years.
Special Cases:
- Elderly Patients: Use with caution due to potential for increased systemic absorption. Monitor for adverse effects.
- Patients with Renal Impairment: Caution is advised, as salicylic acid is excreted renally. Monitor for signs of salicylate toxicity.
- Patients with Hepatic Dysfunction: Caution is advised, as both salicylic acid and hydrocortisone are metabolized in the liver.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, as topical corticosteroids can affect blood glucose control.
Clinical Use Cases
Dosage recommendations for specific clinical use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not applicable as this medication is for topical use only.
Dosage Adjustments
Dosage adjustment is not usually required, but treatment duration should be limited to avoid adverse effects.
Side Effects
Common Side Effects
Itching, burning, stinging, dryness, irritation, and redness at the application site.
Rare but Serious Side Effects
Allergic contact dermatitis, skin atrophy, telangiectasia, hypopigmentation, hyperglycemia (with prolonged use or large areas of application).
Long-Term Effects
Skin thinning, striae, and changes in skin pigmentation can occur with prolonged use, especially with high-potency corticosteroids.
Adverse Drug Reactions (ADR)
Severe skin reactions, adrenal suppression (with prolonged use or use over large areas).
Contraindications
Hypersensitivity to any of the components. Avoid use on open wounds, burns, or infected skin. Not recommended for children under 2. Avoid application to the face or near the eyes, mouth, or nose.
Drug Interactions
May interact with other topical medications, including retinoids and other corticosteroids. Concurrent use of oral salicylates can increase the risk of salicylate toxicity.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding is not well established. Consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: Keratolytic, anti-inflammatory, and antifungal.
- Side Effects: Itching, burning, dryness, redness. Rarely, skin atrophy, allergic contact dermatitis.
- Contraindications: Hypersensitivity, open wounds, burns, infected skin, children under 2.
- Drug Interactions: Topical retinoids, other corticosteroids, oral salicylates.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: Apply thinly twice daily to affected areas.
- Monitoring Parameters: Monitor the affected skin area for signs of irritation, atrophy, or other adverse effects.
Popular Combinations
This medication itself is a combination product. No other popular combinations are frequently recommended.
Precautions
Avoid contact with eyes, mouth, and mucous membranes. Discontinue if irritation develops. Monitor for systemic effects with prolonged use or large areas of application.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Benzoic Acid + Hydrocortisone + Salicylic Acid?
A: Apply a thin layer to the affected skin area twice a day. Do not use for more than two weeks without consulting a physician.
Q2: Can this ointment be used on the face?
A: Use with caution on the face and avoid contact with eyes, mouth, and nose.
Q3: Can I use this medication if I am pregnant or breastfeeding?
A: Consult a doctor before use during pregnancy or breastfeeding, as the safety profile is not well established.
Q4: How long does it take to see results?
A: Improvement may be observed within a few days to weeks, depending on the condition.
Q5: What should I do if my condition worsens?
A: Discontinue use and consult your doctor immediately.
Q6: Can this ointment be used on broken skin?
A: Avoid use on open wounds, burns, or infected skin.
Q7: What are the potential long-term side effects?
A: Skin thinning, striae, changes in skin pigmentation can occur with prolonged use.
Q8: Can this be used in children?
A: Use with caution in children above two years and under the guidance of a pediatrician. Not for use in infants under 2.
Q9: How should I store this medication?
A: Store at room temperature away from moisture and heat. Keep out of reach of children.
