clotrimazole + hydrocortisone acetate: clinical use

Prescribing considerations

• Confirm a fungal diagnosis with clinically significant inflammation; clotrimazole alone may be more appropriate without inflammation.
• Absorption can increase through inflamed or damaged skin, skin folds, large areas or occlusion.
• Children are more susceptible to systemic corticosteroid effects.
• Consider alternative diagnoses, contact allergy or secondary infection if the condition worsens or fails to respond.
• Refer for ophthalmic assessment if visual disturbance develops.

Contraindications and cautions

• Hypersensitivity to clotrimazole, hydrocortisone acetate or an excipient.
• Broken skin, large treatment areas, face, eyes, mouth or mucous membranes.
• Untreated bacterial or viral skin disease, including herpes infections, chickenpox or shingles.
• Acne, rosacea, perioral dermatitis, cutaneous tuberculosis, syphilitic skin disease or vaccination reactions.
• Use in children younger than 10 years, during pregnancy or breastfeeding, or on anogenital skin or ringworm unless prescribed by a doctor.

Monitoring

• Clinical response and worsening infection or inflammation.
• Local irritation, allergic contact dermatitis, secondary infection and corticosteroid-related skin changes.
• Visual symptoms.
• Features of systemic corticosteroid exposure when absorption risk is increased.

Clinical pharmacology

Clotrimazole inhibits fungal ergosterol synthesis and impairs cell-membrane function. Hydrocortisone acetate is a weak glucocorticoid with anti-inflammatory, antipruritic, antiallergic and vasoconstrictive effects. Clotrimazole absorption through skin is minimal; hydrocortisone absorption varies with skin condition, site, area and occlusion.

Formulation and product differences

• The product is a white cutaneous cream supplied in an aluminium tube.
• Cetostearyl alcohol may cause local contact dermatitis.
• Benzyl alcohol may cause allergic reactions or mild local irritation.