Usage
Mometasone + Salicylic Acid is prescribed for the topical treatment of inflammatory skin disorders, primarily moderate to severe plaque psoriasis, eczema, and seborrheic dermatitis. It is also used to treat corns and calluses. This combination medication falls under the pharmacological classifications of corticosteroids and keratolytics.
Mometasone, a corticosteroid, exerts its anti-inflammatory action by binding to glucocorticoid receptors in skin cells. This leads to a decrease in the production of inflammatory mediators, reducing redness, swelling, and itching. Salicylic acid, a keratolytic, enhances the penetration of mometasone by exfoliating the skin and removing the thickened scales characteristic of psoriasis. It softens keratin, promoting the shedding of dead skin cells, which contributes to a smoother skin texture.
Alternate Names
While the generic name is Mometasone + Salicylic Acid, it’s marketed under various brand names such as Elosalic, Momate-S, and others depending on the region and manufacturer.
How It Works
Pharmacodynamics: Mometasone, a high-potency corticosteroid, reduces inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. It also inhibits the synthesis of inflammatory cytokines. Salicylic acid, a beta-hydroxy acid, works by increasing skin hydration and dissolving the intercellular cement that holds skin cells together, encouraging exfoliation.
Pharmacokinetics: When applied topically, mometasone is minimally absorbed into the systemic circulation. Salicylic acid is absorbed percutaneously, with the extent of absorption dependent on factors such as the concentration used, the vehicle, and the condition of the skin.
Mode of Action: The combined action of mometasone and salicylic acid provides synergistic benefits. Salicylic acid’s keratolytic action improves the penetration of mometasone into the skin, augmenting its anti-inflammatory effect.
Elimination Pathways: Mometasone is primarily metabolized in the liver and excreted in the bile and urine. Salicylic acid is conjugated in the liver and excreted mainly in the urine.
Dosage
Standard Dosage
Adults: Apply a thin layer of the cream/ointment/lotion to the affected area once or twice daily. The maximum daily dose is 15g, and the treated area should not exceed 30% of the body surface area. Treatment duration should generally not exceed 3 weeks unless directed by a physician.
Children:
- 2 years and older: Apply a thin layer of cream or ointment to the affected area once a day. Lotion is not recommended for children below 12 years of age.
- Under 2 years: Use is generally not recommended.
Special Cases:
- Elderly Patients: Similar dosing to adults, but monitor for adverse effects, especially skin atrophy.
- Patients with Renal Impairment: Caution advised. Monitor closely for systemic side effects. Dosage adjustments may be needed.
- Patients with Hepatic Dysfunction: Caution advised. Monitor closely for systemic side effects. Dosage adjustments may be needed.
- Patients with Comorbid Conditions: Caution is recommended in patients with diabetes, Cushing’s disease, glaucoma, cataract, thyroid disease, pituitary disease, and cardiovascular or liver problems. Monitor for any exacerbation of these conditions.
Clinical Use Cases
Mometasone + Salicylic Acid is intended for topical dermatological use. It is not indicated for use in clinical settings like intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations.
Dosage Adjustments
Dosage modifications should be considered based on patient-specific factors such as renal or hepatic impairment, the severity of the skin condition, and individual patient response.
Side Effects
Common Side Effects
- Burning or stinging at the application site
- Itching
- Dryness
- Redness
- Skin peeling
Rare but Serious Side Effects
- Skin atrophy (thinning)
- Telangiectasia (spider veins)
- Hypopigmentation (skin lightening)
- Hypertrichosis (increased hair growth)
- Allergic contact dermatitis
- Adrenal suppression (with prolonged or extensive use)
- Worsening of existing skin infections
Long-Term Effects
- Skin atrophy
- Striae (stretch marks)
- Changes in skin pigmentation
- Cushing’s syndrome (with widespread and prolonged use)
Adverse Drug Reactions (ADR)
Severe skin reactions, signs of adrenal suppression (fatigue, weakness, weight loss), and infections at the application site require immediate medical attention.
Contraindications
- Hypersensitivity to mometasone, salicylic acid, or any component of the formulation.
- Viral skin infections (e.g., herpes simplex, varicella)
- Fungal skin infections
- Tuberculous skin infections
- Syphilis lesions on the skin
- Rosacea
- Acne
- Perioral dermatitis
- Open wounds or ulcers
Drug Interactions
- Other topical corticosteroids: Increased risk of systemic side effects
- Topical acne medications (e.g., benzoyl peroxide, tretinoin): Potential for irritation or reduced efficacy
- Oral corticosteroids: Increased risk of systemic corticosteroid effects
- Medications metabolized by CYP3A4: Potential for altered metabolism of either drug
Pregnancy and Breastfeeding
- Pregnancy: While considered relatively safe due to low systemic absorption, use only if clearly needed and under the guidance of a physician, especially during the first trimester. Not recommended during the third trimester due to the salicylic acid component.
- Breastfeeding: Exercise caution. Mometasone is excreted in breast milk in small amounts. Consider potential effects on the nursing infant.
Drug Profile Summary
- Mechanism of Action: Mometasone: Anti-inflammatory corticosteroid; Salicylic Acid: Keratolytic, enhances mometasone penetration.
- Side Effects: Burning, itching, dryness, redness, skin atrophy, telangiectasia.
- Contraindications: Hypersensitivity, viral/fungal/bacterial skin infections, rosacea, acne, open wounds.
- Drug Interactions: Other topical corticosteroids, acne medications, oral corticosteroids.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: Adults and children 2 years and above, apply a thin layer once or twice daily (cream/ointment).
- Monitoring Parameters: Skin condition, signs of local or systemic side effects.
Popular Combinations
Mometasone + Salicylic Acid itself is a popular combination. Combining it with other topical medications should be done cautiously and under medical supervision.
Precautions
- General Precautions: Avoid application near eyes or mucous membranes. Do not use occlusive dressings unless specifically instructed. Monitor for signs of skin irritation or infection. Wash hands after application.
- Specific Populations: See section on “Dosage - Special Cases”.
- Lifestyle Considerations: Avoid smoking, as it can exacerbate some skin conditions. Limit alcohol intake, as it can interact with some medications.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to affected area once or twice daily for adults and children over 2 years (cream/ointment only). Do not use for more than 3 weeks without consulting a doctor.
A: Generally avoid use on the face unless specifically directed by a physician due to increased risk of side effects like skin atrophy and telangiectasia.
Q3: What should I do if my skin condition worsens while using this medication?
A: Discontinue use and consult your physician immediately.
Q4: Can I use this medication while pregnant or breastfeeding?
A: Consult your doctor before use during pregnancy or breastfeeding. It’s generally avoided during the third trimester.
Q5: What are the signs of an allergic reaction to this medication?
A: Severe itching, burning, swelling, hives, or difficulty breathing. Seek immediate medical attention if these occur.
Q6: Can I use this medication on open wounds or cuts?
A: No. Avoid application on broken skin, open wounds, or ulcers.
A: You should see improvement within a few days to two weeks. Consult your doctor if you don’t observe any improvement within this timeframe.
Q8: What happens if I miss a dose?
A: Apply the missed dose as soon as you remember. Do not double the dose to catch up.
A: Consult your doctor before combining it with other topical medications, as this could increase the risk of adverse effects or interactions.
