Usage
This combination cream is prescribed for the treatment of various superficial skin infections caused by bacteria and fungi, along with inflammatory dermatoses, such as:
- Dermatitis
- Eczema
- Psoriasis
- Athlete’s foot
- Ringworm
- Yeast infections
- Sweat rash
Pharmacological Classifications: This medication combines drugs from several classes to provide comprehensive treatment:
- Corticosteroid (Clobetasol propionate): Potent, topical anti-inflammatory and antipruritic.
- Antibiotic (Ofloxacin): Broad-spectrum fluoroquinolone, targeting bacterial infections.
- Antifungal (Miconazole nitrate and Terbinafine hydrochloride): Effective against a variety of dermatophytes and yeasts.
- Emollient (Dexpanthenol): Moisturizer that aids in skin repair.
Mechanism of Action: Each component works synergistically:
- Clobetasol: Suppresses inflammation by inhibiting chemical messengers that cause redness, swelling, and itching.
- Ofloxacin: Interferes with bacterial DNA replication and repair, halting bacterial growth.
- Miconazole and Terbinafine: Disrupt fungal cell membrane formation, killing and preventing fungal growth.
- Dexpanthenol: Softens and moisturizes, reducing itching and flaking, and promoting healing.
Alternate Names
This combination cream is marketed under various brand names, including:
- Derm Cream
- Terbol Forte Cream
- Terbicort-Total Cream
- Zoyclo-M Plus Cream
- Zyciderm Plus Cream
- Olciderm
- Terclo Cream
How It Works
Pharmacodynamics:
The combined effect of this cream targets both bacterial and fungal infections while mitigating inflammation and promoting skin repair. The corticosteroid reduces inflammatory responses, the antibiotic eliminates bacteria, and the antifungals eradicate fungi. The emollient supports skin barrier function and aids in healing.
Pharmacokinetics:
- Absorption: Primarily topical with limited systemic absorption. Enhanced if applied to broken or damaged skin, potentially increasing systemic effects.
- Metabolism: Information on the metabolism of this specific combination is limited. However, it is known that topical corticosteroids are metabolized primarily in the liver. Ofloxacin is partially metabolized in the liver. Terbinafine is extensively metabolized in the liver by CYP enzymes.
- Elimination: Topical corticosteroids, as well as their metabolites, are primarily excreted in the urine and bile. Ofloxacin is excreted in the urine and feces. Terbinafine and its metabolites are excreted primarily in the urine.
Mode of Action:
- Clobetasol: Binds to glucocorticoid receptors in the cytoplasm, influencing gene transcription and resulting in decreased inflammation.
- Ofloxacin: Inhibits DNA gyrase, crucial for bacterial DNA replication and repair.
- Miconazole: Inhibits ergosterol synthesis, a key component of fungal cell membranes.
- Terbinafine: Inhibits squalene epoxidase, also involved in ergosterol synthesis.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area twice daily, or as directed by a physician. Treatment duration depends on the severity and type of infection.
Children:
Use in children below 12 years of age is generally not recommended due to the potent corticosteroid component. If used, application should be limited to a small area and for a short duration, under strict medical supervision. Pediatric dosage adjustments should be made according to weight and medical condition, always considering safety first.
Special Cases:
- Elderly Patients: Use with caution due to the increased risk of skin atrophy with prolonged use of potent corticosteroids.
- Patients with Renal Impairment: Caution advised, particularly with prolonged or high-dose use.
- Patients with Hepatic Dysfunction: Caution advised, particularly with prolonged or high-dose use.
- Patients with Comorbid Conditions: Evaluate for potential drug interactions and monitor for adverse effects.
Clinical Use Cases
This topical combination cream is not typically used in settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is intended for topical application on the skin.
Dosage Adjustments
Dose modification may be required based on individual patient factors, pre-existing medical conditions, and response to treatment. Close monitoring is recommended.
Side Effects
Common Side Effects
- Burning sensation
- Irritation
- Itching
- Redness
- Skin peeling
- Skin thinning
- Changes in skin color
- Dryness
- Application site reactions (burning, irritation, itching, and redness)
Rare but Serious Side Effects
- Allergic reactions
- Skin atrophy
- Telangiectasia (spider veins)
- Hypopigmentation
- Hypertrichosis (increased hair growth)
- Secondary infections
Long-Term Effects
- Skin thinning
- Atrophy
- Striae (stretch marks)
Adverse Drug Reactions (ADR)
- Severe allergic reactions
- Worsening infection
- Systemic corticosteroid effects with excessive use
Contraindications
- Hypersensitivity to any of the components
- Viral skin infections (e.g., herpes simplex, varicella zoster)
- Untreated parasitic infections
- Fungal infections not susceptible to terbinafine (e.g., candidiasis)
- Rosacea
- Acne
Drug Interactions
- Potential interactions with other topical corticosteroids
- May interact with certain oral medications (e.g., codeine, tizanidine, selegiline, rasagiline, disopyramide, quinidine, warfarin, atazanavir, ketoconazole, fluconazole, rifampicin, acarbose). Always review the patient’s medication history.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been established. Use with caution only if benefits outweigh risks. Consult with a specialist.
Drug Profile Summary
- Mechanism of Action: Anti-inflammatory, antibacterial, antifungal, and emollient.
- Side Effects: Local skin reactions (burning, irritation, itching, redness), skin thinning, atrophy.
- Contraindications: Hypersensitivity, viral infections, rosacea, acne.
- Drug Interactions: Potential interactions with other topical corticosteroids and certain oral medications.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Apply thinly to affected area twice daily.
- Monitoring Parameters: Local skin reactions, signs of infection resolution, potential adverse effects.
Popular Combinations
This cream itself combines several active ingredients. Combining it with additional topical medications is generally not recommended unless specifically instructed by a physician.
Precautions
- Avoid contact with eyes and mucous membranes.
- Use on open wounds or broken skin with caution.
- Do not use under occlusive dressings unless directed.
- Monitor for signs of skin atrophy or other adverse effects.
- Pre-existing medical conditions may require dose adjustments or close monitoring.
- Alcohol: consult your doctor as interaction information is limited
- Pregnancy: consult your doctor as safety has not been established
- Breastfeeding: consult your doctor as safety has not been established.
- Children: use in children under 12 years old is not recommended due to the potent corticosteroid.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clobetasol + Dexpanthenol + Miconazole + Ofloxacin + Terbinafine?
A: Apply a thin layer to the affected area twice daily for adults. Use in children under 12 is not recommended.
Q2: What skin conditions is this cream used for?
A: It’s used for superficial bacterial and fungal skin infections, along with inflammatory conditions like dermatitis, eczema, and psoriasis.
Q3: Can this cream be used on the face?
A: Use on the face should be under the guidance of a physician due to the potential for skin thinning and other adverse effects. Limit application to small areas and short durations.
Q4: Can I use this cream if I’m pregnant or breastfeeding?
A: Safety during pregnancy and breastfeeding is not established. Consult with a specialist.
Q5: What are the common side effects?
A: Common side effects include burning, irritation, itching, redness, skin peeling, and thinning at the application site.
Q6: What should I do if I experience side effects?
A: If you experience any concerning side effects, discontinue use and consult with your physician.
Q7: How long should I use this cream?
A: The duration of treatment depends on the condition and its severity, as determined by your physician.
Q8: Can this cream be used with other topical medications?
A: Generally, combining this cream with other topical medications is not recommended unless specifically directed by a physician due to potential interactions.
Q9: How should I store this cream?
A: Store at room temperature away from excessive heat and moisture. Keep out of reach of children.
Q10: Is this cream suitable for all types of fungal infections?
A: This cream is effective against many, but not all, fungal infections. Some fungal infections, like candidiasis, may require a different treatment approach. Consult your doctor for an accurate diagnosis and appropriate treatment recommendation.
