Usage
This combination cream is prescribed for inflammatory and pruritic dermatoses complicated by secondary bacterial and/or fungal infections. Conditions this medication treats include:
- Eczema
- Psoriasis
- Dermatitis (various types)
- Athlete’s foot (Tinea pedis)
- Jock itch (Tinea cruris)
- Ringworm (Tinea corporis)
- Seborrheic dermatitis
Pharmacological Classification: This is a combination product containing:
- Corticosteroid: Clobetasol propionate (anti-inflammatory, antipruritic)
- Antifungals: Ketoconazole, Tolnaftate, Clioquinol (Iodochlorhydroxyquinoline)
- Antibiotic: Neomycin
- Emollient: Dexpanthenol
Mechanism of Action: This cream combines multiple actions to address skin infections:
- Clobetasol reduces inflammation and itching by suppressing the immune response.
- Ketoconazole and Tolnaftate inhibit ergosterol synthesis, a critical part of fungal cell membranes, leading to fungal cell death.
- Clioquinol has antifungal activity by affecting fungal DNA synthesis and some antibacterial action.
- Neomycin inhibits bacterial protein synthesis, causing bacterial cell death.
- Dexpanthenol enhances skin hydration and regeneration.
Alternate Names
- Dermi-Zio 6 Cream
- CLOBAL GM Cream
- Dermiford Cream
- Various brand names depending on the manufacturer
How It Works
Pharmacodynamics: The combined ingredients work synergistically. The corticosteroid reduces inflammation and itching, while the antifungals and antibiotic target the microbial pathogens.
Pharmacokinetics: Topical application limits systemic absorption, although some absorption can occur with prolonged use or application to large areas, thin skin, or broken skin. Metabolism and excretion data for topical formulations of the combined components are not routinely assessed.
Mode of Action:
- Clobetasol: Binds to glucocorticoid receptors, modulating gene expression and reducing inflammatory responses.
- Ketoconazole & Tolnaftate: Inhibit fungal ergosterol synthesis.
- Clioquinol: Interferes with fungal DNA synthesis and bacterial cell membrane function.
- Neomycin: Binds to bacterial ribosomes, inhibiting protein synthesis.
Elimination Pathways: Primarily through topical clearance. Systemic absorption is limited, with any absorbed drug metabolized and excreted via renal or hepatic pathways.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected area twice daily. Do not exceed 50g per week. Treatment should not typically exceed two weeks.
Children: Use in children is not recommended unless under strict medical supervision. Minimize treated area and duration of therapy.
Special Cases:
- Elderly Patients: Use with caution due to increased risk of skin thinning and systemic absorption.
- Patients with Renal Impairment: Caution advised, especially with prolonged or large-area use. Monitor for systemic absorption signs.
- Patients with Hepatic Dysfunction: Caution advised due to potential for altered metabolism.
- Patients with Comorbid Conditions: Evaluate underlying conditions, especially diabetes and cardiovascular disease.
Clinical Use Cases
This combination cream is primarily used for dermatological conditions in outpatient settings and isn’t generally indicated for intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments may be needed based on individual patient factors, including condition severity, patient age, and response to treatment.
Side Effects
Common Side Effects:
- Itching
- Burning
- Irritation
- Skin peeling
- Dryness
- Redness
- Stinging
Rare but Serious Side Effects:
- Skin atrophy
- Telangiectasia (spider veins)
- Striae (stretch marks)
- Hypopigmentation
- Hypertrichosis
- Folliculitis
- Allergic contact dermatitis
- Systemic absorption of corticosteroids
Long-Term Effects:
- Skin thinning
- Permanent skin discoloration
- Increased susceptibility to skin infections
Adverse Drug Reactions (ADR):
- Severe allergic reactions (anaphylaxis) – rare but require immediate medical attention. Report any signs of systemic corticosteroid absorption to a physician.
Contraindications
- Hypersensitivity to any component.
- Viral skin infections (e.g., herpes simplex, varicella, vaccinia)
- Tuberculous or syphilitic skin lesions
- Rosacea
- Acne
- Perioral dermatitis
Drug Interactions
- Concurrent topical medications may increase irritation or adverse effects.
- Inform patients about potential interactions with oral corticosteroids or immunosuppressants.
Pregnancy and Breastfeeding
- Pregnancy: Clioquinol, clobetasol, and neomycin should be used with caution during pregnancy.
- Breastfeeding: Safety not fully established. Topical application minimizes infant exposure, but avoid applying to areas that might contact the infant.
Drug Profile Summary (See dedicated sections for details)
Popular Combinations
This combination as formulated is itself a popular combination for treating dermatoses with secondary infections.
Precautions (See dedicated sections for details)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clioquinol + Clobetasol + Dexpanthenol + Ketoconazole + Neomycin + Tolnaftate?
A: Adults: Apply a thin layer twice daily, not exceeding 50g/week for up to 2 weeks. Pediatric use is not recommended unless under strict medical supervision.
Q2: What conditions does this combination cream treat?
A: Inflammatory skin conditions complicated by secondary bacterial and/or fungal infections, such as eczema, psoriasis, dermatitis, athlete’s foot, jock itch, ringworm, and seborrheic dermatitis.
Q3: What are the major contraindications for this cream?
A: Hypersensitivity, viral skin infections, tuberculous or syphilitic skin lesions, rosacea, acne, and perioral dermatitis.
Q4: Are there any significant drug interactions?
A: Concurrent use of other topical medications, oral corticosteroids, or immunosuppressants may interact.
Q5: Can this cream be used during pregnancy or breastfeeding?
A: Use with caution during pregnancy and breastfeeding. Consult a physician. Topical application minimizes infant exposure, but avoid applying to areas that might contact the infant.
Q6: What are the common side effects?
A: Itching, burning, irritation, skin peeling, dryness, redness, and stinging. More serious side effects are possible.
Q7: How should this cream be applied?
A: Apply a thin layer to the affected area. Avoid contact with eyes, nose, and mouth. Do not use occlusive dressings unless directed by a doctor.
Q8: What if the condition doesn’t improve after two weeks?
A: Consult a physician. Prolonged use of topical corticosteroids can lead to skin thinning and other adverse effects.
Q9: Can this medication stain clothing?
A: Yes, the clioquinol component can stain clothing, skin, hair, and nails yellow.
Q10: Should I avoid any other medications while using this cream?
A: Inform your doctor about all medications you are currently using, including topical and oral medications.
