Usage
This combination medication is a topical preparation indicated for inflammatory dermatoses, especially where secondary bacterial and/or fungal infections are present or suspected. It is prescribed for conditions such as:
- Infected eczema and dermatitis
- Intertrigo
- Tinea infections (e.g., athlete’s foot, ringworm)
- Minor infected wounds or burns
- Otitis externa
Pharmacological Classification:
- Corticosteroid (Betamethasone)
- Antibiotic (Gentamicin)
- Antifungal (Tolnaftate and Clioquinol)
Mechanism of Action: This combination product works through the synergistic action of its components:
- Betamethasone: Provides anti-inflammatory and antipruritic effects by inhibiting the release of inflammatory mediators.
- Gentamicin: An aminoglycoside antibiotic that inhibits bacterial protein synthesis.
- Tolnaftate: Antifungal agent that inhibits ergosterol synthesis, disrupting fungal cell membrane formation.
- Clioquinol: Exerts antifungal and antibacterial effects by disrupting cell membrane function.
Alternate Names
- Quadriderm
- Amiderm
- Uniderm
- Polyderm 4
- Quatroderm
- Tigboderm
- Dermitop
- Quadri Mix
- Betamethasone + Gentamicin + Tolnaftate + Iodochlorhydroxyquin
- Betamethasone valerate + Gentamicin sulfate + Tolnaftate + Clioquinol
- ซีโต้-เดิร์ม (Thailand)
- DERMA - 3 (Colombia)
How It Works
Pharmacodynamics: The combined effect of the four components addresses the inflammatory and infectious aspects of dermatological conditions. Betamethasone reduces inflammation and itching, while gentamicin, tolnaftate, and clioquinol combat bacterial and fungal infections.
Pharmacokinetics:
- Absorption: Primarily topical; systemic absorption is minimal under normal use but can increase with prolonged use, application to large areas, or use of occlusive dressings.
- Metabolism: Betamethasone is metabolized primarily in the liver. Gentamicin, tolnaftate, and clioquinol are minimally metabolized when applied topically.
- Elimination: Betamethasone metabolites are excreted primarily in the urine and bile. Gentamicin is excreted renally, while tolnaftate and clioquinol are primarily excreted unchanged in the feces and urine.
Dosage
Standard Dosage
Adults: Apply a thin film to the affected area two to three times daily.
Children: Not recommended for children under 2 years of age. For children over 2 years, use as directed by a physician. Dosage adjustments may be necessary based on age and body weight.
Special Cases:
- Elderly Patients: No specific dosage adjustments, but use with caution, especially with prolonged application.
- Patients with Renal Impairment: Systemic absorption is minimal, but monitor for potential systemic effects with prolonged or extensive use.
- Patients with Hepatic Dysfunction: Monitor for potential increased systemic levels of betamethasone with prolonged or extensive use.
- Patients with Comorbid Conditions: Evaluate the overall clinical picture, particularly in patients with diabetes, as corticosteroids can affect glucose control.
Clinical Use Cases The dosage for this combination product is not generally adjusted for specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is designed for topical dermatological use.
Dosage Adjustments
Adjustments may be needed based on the severity of the condition and patient response. For tinea pedis, longer therapy (2-4 weeks) may be required.
Side Effects
Common Side Effects:
- Burning
- Itching
- Irritation
- Dryness
Rare but Serious Side Effects:
- Allergic contact dermatitis
- Hypopigmentation
- Skin atrophy
- Striae
Long-Term Effects:
- Skin thinning
- Telangiectasia (spider veins) with prolonged use of topical corticosteroids.
Adverse Drug Reactions (ADR):
- Angioedema
- Urticaria (hives)
Contraindications
- Hypersensitivity to any component
- Viral skin infections (herpes simplex, vaccinia, varicella)
- Tuberculosis of the skin
- Rosacea, acne, and perioral dermatitis (around the mouth) should be considered relative contraindications, especially with potent corticosteroids.
Drug Interactions
Limited information available on drug interactions. Concomitant use of other topical medications on the same area should be avoided unless directed by a physician.
Pregnancy and Breastfeeding
- Pregnancy: Not recommended unless the potential benefit outweighs the risk to the fetus.
- Breastfeeding: Use with caution. Avoid applying to the breast area.
Drug Profile Summary
- Mechanism of Action: Combined anti-inflammatory, antibacterial, and antifungal action.
- Side Effects: Local irritation, dryness, hypopigmentation, rarely allergic reactions.
- Contraindications: Hypersensitivity, viral skin infections, skin tuberculosis.
- Drug Interactions: Limited information. Avoid concurrent topical medications.
- Pregnancy & Breastfeeding: Use with caution; not recommended during pregnancy unless essential.
- Dosage: Apply a thin layer 2-3 times daily.
- Monitoring Parameters: Skin irritation, signs of infection, and response to treatment.
Popular Combinations
This product itself represents a combination of active ingredients. No other specific combinations are typically recommended.
Precautions
- Avoid contact with eyes and mucous membranes.
- Not for ophthalmic use.
- Do not use with occlusive dressings unless directed by a physician.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Betamethasone + Clioquinol + Gentamicin + Tolnaftate?
A: Apply a thin layer to the affected area two to three times a day.
Q2: Can this combination be used on the face?
A: Use with caution on the face; avoid prolonged use due to the risk of skin thinning and telangiectasia.
Q3: What should I do if my symptoms don’t improve?
A: Consult a physician for reassessment of the diagnosis and treatment plan.
Q4: Can I use this cream if I’m pregnant or breastfeeding?
A: It is generally not recommended during pregnancy unless the potential benefit outweighs the risk. If breastfeeding, use with caution and avoid applying to the breast area.
Q5: How long can I use this medication?
A: Typical treatment duration is 5-10 days, but it can be extended to 2-4 weeks for certain conditions like tinea pedis, as directed by the physician.
Q6: Are there any drug interactions I should be aware of?
A: Limited information is available on drug interactions. Avoid using other topical medications concurrently on the same area unless advised by a physician.
Q7: What are the signs of an allergic reaction to this cream?
A: Allergic reactions can manifest as increased itching, redness, swelling, or a rash extending beyond the application site. Seek medical advice if any of these occur.
Q8: Can this cream be used on children?
A: Not recommended for children under 2 years old. For older children, consult a physician for appropriate dosing and monitoring.
Q9: What are the potential long-term effects of using this cream?
A: Prolonged use of topical corticosteroids like betamethasone can lead to skin thinning, telangiectasia (spider veins), and changes in skin pigmentation.
