Usage
Crotamiton + Hydrocortisone is prescribed for the relief of inflammation and itching associated with various skin conditions, including:
- Allergic or irritant contact dermatitis
- Mild to moderate eczema
- Insect bite reactions
- Scabies
Pharmacological Classification:
- Crotamiton: Antiparasitic, scabicide, antipruritic
- Hydrocortisone: Corticosteroid, anti-inflammatory, antipruritic
Mechanism of Action:
Crotamiton disrupts the nervous system of scabies mites, leading to their paralysis and death. It also has a mild local anesthetic effect. Hydrocortisone binds to glucocorticoid receptors in skin cells, reducing the production of inflammatory mediators. The combination provides dual action against scabies and the associated inflammation and itching.
Alternate Names
While “Crotamiton + Hydrocortisone” is the generic name, several brand names exist, such as Eurax HC and Crotorax HC.
How It Works
Pharmacodynamics:
Crotamiton kills scabies mites and their eggs, and also relieves itching. Hydrocortisone suppresses the inflammatory response, reducing redness, swelling, and itching.
Pharmacokinetics:
- Absorption: Minimal systemic absorption with topical application.
- Metabolism: Hydrocortisone is metabolized primarily in the liver.
- Elimination: Hydrocortisone metabolites are primarily excreted renally.
Mode of Action:
Crotamiton targets the nervous system of mites. Hydrocortisone binds to glucocorticoid receptors, affecting gene transcription and reducing inflammatory mediator production.
Receptor binding, enzyme inhibition, or neurotransmitter modulation:
Hydrocortisone exerts its effect through binding to glucocorticoid receptors. Crotamiton’s mechanism isn’t fully elucidated but involves disruption of mite neuronal function.
Elimination pathways:
Hydrocortisone is metabolized in the liver and excreted by the kidneys. Crotamiton, when absorbed systemically, is also primarily metabolized hepatically and renally cleared.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area(s) 1-2 times daily. Do not use for more than 7-14 days continuously.
Children:
- Under 3 years: Use only under strict medical supervision, typically once daily.
- 3 years and older: Similar to adult dosage, 1-2 times daily.
Special Cases:
- Elderly Patients: Use with caution due to the risk of skin thinning and other corticosteroid-related side effects.
- Patients with Renal Impairment: No specific dose adjustment is usually needed for topical application. Monitor for systemic effects with prolonged use over large areas.
- Patients with Hepatic Dysfunction: Use with caution, as hydrocortisone is metabolized in the liver.
- Patients with Comorbid Conditions: Exercise caution in patients with diabetes, hypertension, or other conditions potentially aggravated by corticosteroids.
Clinical Use Cases
Crotamiton + Hydrocortisone is generally not indicated for use in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments are based on the patient’s response and the severity of the skin condition. Start with the lowest effective dose.
Side Effects
Common Side Effects:
- Itching
- Rash
- Erythema (skin redness)
- Skin irritation
- Burning or stinging sensation
Rare but Serious Side Effects:
- Allergic reactions (hives, angioedema, difficulty breathing)
- Worsening of skin condition
- Skin atrophy (thinning) with prolonged use
Long-Term Effects:
- Skin thinning, striae (stretch marks), telangiectasia (spider veins) with prolonged high-potency corticosteroid use
Adverse Drug Reactions (ADR):
- Severe allergic reactions
- Cushing’s syndrome (with prolonged use of high-potency corticosteroids over large body surface areas)
Contraindications
- Hypersensitivity to crotamiton or hydrocortisone.
- Bacterial, viral, or fungal skin infections.
- Open wounds or broken skin.
- Acute exudative dermatoses.
Drug Interactions
Limited information is available on drug interactions with topical Crotamiton + Hydrocortisone. It is prudent to inform patients about potential additive effects with other topical corticosteroids or antipruritics. Other topical medications applied to the same area should be used cautiously.
Pregnancy and Breastfeeding
Pregnancy: Not recommended, especially during the first trimester. Consult a physician if the benefits outweigh the risks.
Breastfeeding: Limited data available. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Crotamiton kills scabies mites. Hydrocortisone reduces inflammation.
- Side Effects: Itching, rash, erythema, skin irritation.
- Contraindications: Hypersensitivity, skin infections.
- Drug Interactions: Limited information available.
- Pregnancy & Breastfeeding: Consult physician.
- Dosage: Apply thinly 1-2 times daily.
- Monitoring Parameters: Assess skin condition for improvement and side effects.
Popular Combinations
Crotamiton + Hydrocortisone is itself a combination product. Additional medications may be prescribed for specific conditions (e.g., oral antihistamines for severe itching).
Precautions
- External use only. Avoid contact with eyes, mouth, and mucous membranes.
- Not for use on broken skin or open wounds.
- Use caution in children under 3 years of age.
- Monitor for long-term side effects with prolonged use.
- Avoid occlusive dressings.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Crotamiton + Hydrocortisone?
A: Adults and children over 3 years: Apply a thin layer to affected areas 1-2 times daily. Children under 3: Use only under medical supervision.
Q2: Can I use Crotamiton + Hydrocortisone on my face?
A: Use with caution on the face, avoiding the eyes and mouth. Prolonged use on the face can lead to skin thinning.
Q3: How long does it take for Crotamiton + Hydrocortisone to work?
A: Itching relief may be noticed soon after application, but several days are needed to see improvement in the skin condition.
Q4: What should I do if my condition doesn’t improve?
A: Consult a doctor if your condition worsens or doesn’t improve after 7-14 days of treatment.
Q5: Can I use Crotamiton + Hydrocortisone if I’m pregnant or breastfeeding?
A: Consult your doctor before using this medication during pregnancy or while breastfeeding.
Q6: What are the potential side effects of using Crotamiton + Hydrocortisone for a prolonged period?
A: Long-term use, especially with higher potency corticosteroids, can cause skin thinning, striae (stretch marks), and telangiectasia (spider veins).
Q7: Can I use other topical medications along with Crotamiton + Hydrocortisone?
A: Consult your doctor before using other topical medications concurrently, as they might interact.
Q8: What should I do if I accidentally swallow Crotamiton + Hydrocortisone cream?
A: If ingested, immediately seek medical attention or contact a poison control center.
Q9: Can this cream be used on infected skin lesions?
A: No, Crotamiton + Hydrocortisone is contraindicated in bacterial, viral, or fungal skin infections.
