benzalkonium chloride + dimeticone + hydrocortisone + nystatin: clinical use

Prescribing considerations

• Confirm that Candida contributes to the inflammatory dermatosis.
• Limit exposure to affected skin and avoid large-area occlusion; absorption rises on raw or thin skin, flexures and occluded sites.
• Nappies can act as occlusive dressings. Use particular caution in infants, neonates, older adults and people with hepatic failure.
• Avoid prolonged facial exposure and review deterioration, early recurrence or possible topical steroid withdrawal.
• Advise about the fire risk from contaminated fabrics.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Rosacea
• Perioral dermatitis
• Untreated bacterial, fungal or viral skin infection
• Ulcerated skin

Monitoring

• Clinical response and worsening or spreading infection
• Local sensitisation, irritation, atrophy, striae or telangiectasia
• Features of adrenal suppression or Cushing's syndrome where systemic absorption is more likely
• Rebound redness, burning, peeling or oozing after withdrawal

Clinical pharmacology

Nystatin binds fungal membrane sterols and alters permeability; dimeticone provides a water-repellent barrier; hydrocortisone is a mild anti-inflammatory corticosteroid; benzalkonium chloride is a quaternary ammonium antiseptic. Nystatin, dimeticone and benzalkonium chloride have little or no meaningful skin absorption, while hydrocortisone absorption increases through raw, thin or occluded skin.

Formulation and product differences

• The product is a pale-yellow cream containing four active components.
• Cetostearyl alcohol, sorbic acid, propylene glycol, butylated hydroxyanisole and parabens can cause irritation, contact dermatitis or delayed allergy.
• Store below 15°C. The cream may leave removable yellow staining on terry nappies.