Usage
This combination cream is prescribed for inflammatory skin infections with both bacterial and fungal components. It is effective against a range of dermatological issues, including infected eczema, athlete’s foot with secondary bacterial infections, and dermatitis complicated by fungal or bacterial growth. It also aids in managing conditions like intertrigo and psoriasis with secondary infections.
Pharmacological Classification: This is a combination product with multiple classifications:
- Corticosteroid (Clobetasol)
- Antibiotic (Gentamicin)
- Antifungal (Ketoconazole, Clioquinol, Tolnaftate)
Mechanism of Action: This cream combines the anti-inflammatory action of a corticosteroid, the antibacterial effect of an antibiotic, and the antifungal properties of three distinct agents to provide comprehensive treatment.
Alternate Names
There isn’t a universally recognized generic name for this five-ingredient combination. It is most accurately identified by listing its individual components. Brand names vary regionally and internationally and include “Kitosan-Plus Cream,” “CT Keto Cream,” “KD5 + Cream,” “Dermi 5 Cream,” and “Dermiford Cream.” Some preparations may substitute clotrimazole for ketoconazole.
How It Works
Pharmacodynamics:
- Clobetasol: A potent topical corticosteroid that binds to glucocorticoid receptors in the skin, reducing inflammation by suppressing the immune response and inhibiting the production of inflammatory mediators like prostaglandins.
- Gentamicin: An aminoglycoside antibiotic that inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, leading to bacterial cell death.
- Ketoconazole: An imidazole antifungal that inhibits the synthesis of ergosterol, a vital component of fungal cell membranes. This disruption of membrane integrity results in fungal cell death.
- Clioquinol: An antifungal and antibacterial agent that inhibits DNA synthesis in susceptible organisms, leading to microbial cell death.
- Tolnaftate: A thiocarbamate antifungal that also interferes with ergosterol synthesis, further disrupting fungal cell membrane integrity and inhibiting fungal growth.
Pharmacokinetics: Primarily topical application. Systemic absorption can occur, particularly with prolonged use or application to large areas of damaged skin. Clobetasol is metabolized in the liver. Clioquinol can be nephrotoxic if absorbed systemically.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Clobetasol binds to glucocorticoid receptors. Gentamicin inhibits bacterial protein synthesis by binding to ribosomes. Ketoconazole and Tolnaftate inhibit ergosterol synthesis.
Elimination Pathways: Primarily through skin metabolism and desquamation. Some systemic absorption occurs, with subsequent hepatic metabolism (Clobetasol) and renal excretion (Clioquinol).
Dosage
Dosage is individualized and requires consultation with a dermatologist or healthcare professional. The smallest amount should be used for the shortest duration possible.
Standard Dosage
Adults: A thin layer applied to the affected area 1–2 times daily. Treatment duration should be minimized due to the inclusion of a potent corticosteroid.
Children: Use with extreme caution and only under strict medical supervision. Safety and efficacy not fully established.
Special Cases:
- Elderly Patients: Increased risk of skin thinning (atrophy) and other corticosteroid-related adverse effects. Monitor closely.
- Patients with Renal Impairment: Systemic absorption of Clioquinol can occur. Monitor renal function and consider alternative treatments.
- Patients with Hepatic Dysfunction: Clobetasol is metabolized in the liver, so use with caution and monitor closely.
- Patients with Comorbid Conditions: Evaluate potential drug interactions and patient-specific factors, adjusting treatment as necessary.
Clinical Use Cases
This combination cream is generally not indicated for use in settings such as intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments are made based on patient response, infection severity, and adverse effects.
Side Effects
Common Side Effects:
Burning or stinging sensation, itching, redness, dryness, skin irritation.
Rare but Serious Side Effects:
Skin atrophy, striae (stretch marks), hypopigmentation, telangiectasia (spider veins), allergic contact dermatitis, secondary infections.
Long-Term Effects:
Skin atrophy, striae, telangiectasia, Cushing’s syndrome (with significant systemic absorption).
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), adrenal suppression (with systemic absorption), worsening of infection.
Contraindications
Hypersensitivity to any component, viral skin infections (e.g., herpes simplex, varicella), rosacea, acne, perioral dermatitis, primary bacterial or fungal infections without inflammation.
Drug Interactions
Possible interactions with NSAIDs (increased bleeding risk with oral anticoagulants), systemic antifungals (azole antifungals may inhibit Clobetasol metabolism), other topical corticosteroids (additive effects).
Pregnancy and Breastfeeding
Pregnancy Safety Category: C (consult a physician; insufficient data). Use only if the potential benefit outweighs the risk to the fetus. Unknown if excreted in breast milk; use with caution.
Drug Profile Summary
- Mechanism of Action: Combined anti-inflammatory, antibacterial, and antifungal action.
- Side Effects: Burning, itching, skin thinning, allergic reactions.
- Contraindications: Hypersensitivity, viral skin infections.
- Drug Interactions: NSAIDs, systemic antifungals, topical corticosteroids.
- Pregnancy & Breastfeeding: Use with caution; consult physician.
- Dosage: Topical, 1–2 times daily. Individualized dosing essential.
- Monitoring Parameters: Skin condition, signs of atrophy, renal function (for long-term use), hepatic function (for long-term use).
Popular Combinations (Not Applicable – This is a combination product.)
Precautions
Pre-screen for allergies and contraindications. Avoid use on open wounds, broken skin, or near the eyes. Do not bandage the treated area unless directed by a physician. Caution in elderly patients, pregnant or breastfeeding women, and those with hepatic or renal impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clioquinol + Clobetasol + Gentamicin + Ketoconazole + Tolnaftate?
A: Dosage is individualized based on the patient’s condition and must be determined by a physician. General guidelines suggest applying a thin layer to the affected area 1–2 times daily. Minimize treatment duration.
Q2: What are the main uses of this cream?
A: It is prescribed for inflammatory skin infections with both bacterial and fungal components.
Q3: Can I use this cream on my face?
A: Generally, it’s not recommended due to the risk of skin atrophy, telangiectasia, and perioral dermatitis. Consult a physician.
Q4: What are the common side effects?
A: Burning, itching, dryness, redness, and irritation at the application site.
Q5: Are there any serious side effects I should be aware of?
A: Yes, though rare, skin atrophy, striae, hypopigmentation, allergic reactions, and secondary infections can occur. Prolonged use can cause systemic absorption and adrenal suppression.
Q6: Can I use this cream if I’m pregnant or breastfeeding?
A: Consult your doctor. Use only if the potential benefit outweighs the risk.
Q7: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember and continue with your regular schedule. Do not double the dose.
Q8: Can I use this cream with other medications?
A: Inform your doctor about all other medications, including OTC drugs and supplements. Potential interactions exist.
Q9: How should I store this cream?
A: Store in a cool, dry place away from direct sunlight and out of reach of children.
Q10: What if my condition doesn’t improve?
A: Consult your physician. You may require an alternative treatment.
