Usage
Hydrocortisone + Quiniodochlor is a topical combination medication used to treat various inflammatory dermatological conditions, particularly superficial skin infections complicated by inflammation, such as eczema, athlete’s foot, jock itch, and ringworm. It is also prescribed for inflammatory skin disorders such as seborrheic dermatitis and intertrigo when secondary bacterial or fungal infections are also present.
Pharmacological Classification:
- Hydrocortisone: Corticosteroid, anti-inflammatory agent.
- Quiniodochlor: Antifungal, antibacterial agent.
Mechanism of Action:
Hydrocortisone, a glucocorticoid, works by suppressing the inflammatory response. It inhibits the production of prostaglandins and leukotrienes, which are mediators of inflammation. It also decreases inflammation by reducing the activity of the lymphatic system. Quiniodochlor is an antimicrobial agent that kills microorganisms causing skin infections, including fungi and bacteria, by chelating ferrous ions essential for microbial growth.
Alternate Names
- Corto-Quinol (brand name)
- Vioform Hydrocortisone (Canadian brand name)
- Alcortin (brand name)
- Vytone (brand name)
How It Works
Pharmacodynamics: Hydrocortisone exerts its anti-inflammatory effects by binding to glucocorticoid receptors in the cytoplasm, translocating to the nucleus, and modulating gene transcription. This leads to decreased production of inflammatory mediators. Quiniodochlor acts by chelating divalent cations, such as ferrous ions, which are essential for fungal and bacterial growth.
Pharmacokinetics: Topical application leads to minimal systemic absorption of both drugs. When absorbed systemically, hydrocortisone is metabolized primarily in the liver and excreted by the kidneys. Quiniodochlor is partially metabolized in the liver and primarily excreted in feces.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Hydrocortisone binds to glucocorticoid receptors. Quiniodochlor’s mechanism involves chelation rather than enzyme inhibition or neurotransmitter modulation.
Elimination Pathways: Hydrocortisone is eliminated mainly through renal excretion after hepatic metabolism. Quiniodochlor is primarily eliminated in feces, with partial hepatic metabolism.
Dosage
Standard Dosage
Adults: Apply a thin film of the cream or ointment to the affected area 2 to 4 times daily.
Children:
- Under 2 years: Contraindicated in most countries.
- 2 years and older: A thin film of a 0.5% hydrocortisone and 3% clioquinol combination can be applied to the affected area 2 to 4 times daily. In Canada, a 1% hydrocortisone and 3% clioquinol cream may be used, applied 2 to 3 times daily. Adjust dosage depending on the condition and patient response. Consult local guidelines for regional recommendations.
Special Cases:
- Elderly Patients: Start with the lowest effective dose and monitor for adverse effects due to age-related decreases in hepatic, renal, and/or cardiac function.
- Patients with Renal Impairment: No specific dosage adjustment is typically required for topical application due to minimal systemic absorption. Systemic administration should be approached with caution.
- Patients with Hepatic Dysfunction: Use with caution, as impaired liver function may affect hydrocortisone metabolism. Systemic administration should be approached with caution.
- Patients with Comorbid Conditions: For patients with conditions like diabetes or other metabolic disorders, monitor for systemic effects of hydrocortisone if applied over large areas.
Clinical Use Cases
The combination of hydrocortisone and quiniodochlor is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, the ICU, or emergency situations. Its use is primarily for topical dermatological treatment.
Dosage Adjustments
Dosage adjustments are based on the severity of the condition and patient response. For elderly patients or those with hepatic dysfunction, start with the lowest effective dose.
Side Effects
Common Side Effects:
- Burning
- Itching
- Irritation
- Redness
- Dryness
Rare but Serious Side Effects:
- Skin atrophy (with prolonged use)
- Telangiectasia (with prolonged use)
- Striae (with prolonged use)
- Hypopigmentation
Long-Term Effects:
- Skin thinning
- Stretch marks
- Acne
- Increased hair growth
Adverse Drug Reactions (ADR):
- Allergic contact dermatitis
Contraindications
- Hypersensitivity to hydrocortisone, quiniodochlor, or any component of the formulation
- Tuberculosis of the skin
- Viral skin infections (e.g., herpes simplex, varicella)
- Untreated bacterial skin infections
- Rosacea
- Perioral dermatitis
- Vaccination sites
- Children under 2 years old (in most regions)
Drug Interactions
Drug interactions are limited with topical use. Avoid concomitant application of other topical medications on the same area.
Pregnancy and Breastfeeding
- Pregnancy: Topical use is generally considered safe for short-term use over small areas. Consult a physician before use.
- Breastfeeding: Generally considered safe for short-term topical use over small areas. Avoid applying to the breast or nipple area.
Drug Profile Summary
- Mechanism of Action: Hydrocortisone: Anti-inflammatory (glucocorticoid); Quiniodochlor: Antifungal and antibacterial.
- Side Effects: Burning, itching, irritation, dryness, skin atrophy (long-term use).
- Contraindications: Hypersensitivity, tuberculosis of the skin, viral skin infections.
- Drug Interactions: Limited with topical use. Avoid concomitant application of other topical drugs.
- Pregnancy & Breastfeeding: Consult with a physician. Generally safe for short-term use over small areas.
- Dosage: Apply a thin film 2-4 times daily.
- Monitoring Parameters: Monitor the affected area for irritation, sensitization, or secondary infections.
Popular Combinations
Hydrocortisone + quiniodochlor is typically prescribed as a fixed-dose combination.
Precautions
- General Precautions: Avoid prolonged use, especially over large areas. Avoid use on broken skin or open wounds. Do not use near the eyes.
- Specific Populations: Consult a physician during pregnancy or breastfeeding. Use with caution in children.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Hydrocortisone + Quiniodochlor?
A: Apply a thin film to the affected area 2-4 times daily. The frequency and duration of application will depend on the specific condition being treated and the patient’s response.
Q2: What conditions is Hydrocortisone + Quiniodochlor used to treat?
A: It’s used to treat inflammatory skin disorders complicated by fungal or bacterial infections, such as eczema with secondary infection, athlete’s foot, ringworm, jock itch, and seborrheic dermatitis.
Q3: Are there any contraindications for using this medication?
A: Yes. Contraindications include hypersensitivity, tuberculosis of the skin, viral skin infections, and, in most countries, children under 2.
Q4: What are the common side effects?
A: Common side effects are typically mild and include burning, itching, irritation, dryness, and redness at the application site.
Q5: Can I use this medication during pregnancy or while breastfeeding?
A: Consult your physician before using this medication while pregnant or breastfeeding. Topical use is generally considered safe for short-term use over small areas, but it’s important to discuss the risks and benefits with your doctor.
Q6: Can I use this on my face?
A: While it can be used on the face, exercise caution and avoid prolonged use, as it can lead to skin thinning and other adverse effects. Avoid the area around the eyes.
Q7: What should I do if my symptoms don’t improve?
A: Consult your physician. They may need to adjust your treatment or explore other diagnostic possibilities.
Q8: Can I use other topical medications at the same time?
A: Avoid concomitant use of other topical medications on the treated area unless specifically advised by your physician, as this may increase the risk of interactions or adverse reactions.
Q9: How should I store this medication?
A: Store at room temperature away from excessive heat and moisture. Keep the container tightly closed.
