What is a prescription cream that combines an antifungal and a steroid?

Prescription Creams Combining Antifungals and Steroids

The most common prescription creams that combine antifungals with corticosteroids include clotrimazole-betamethasone dipropionate (Lotrisone) and nystatin-triamcinolone (Mycolog-II), which are used for inflammatory fungal skin infections but should be limited to short-term use due to potential adverse effects.

Available Combination Products

Combination antifungal-corticosteroid creams are prescribed for fungal infections with significant inflammatory components. The most widely used options include:

• Clotrimazole 1% with betamethasone dipropionate 0.05% (Lotrisone)
• Nystatin with triamcinolone acetonide (Mycolog-II)
• Isoconazole nitrate 1% with diflucortolone valerate 0.1% 1

Mechanism and Rationale

These combination products work through:

• The antifungal component (azole or polyene) treats the underlying fungal infection
• The corticosteroid component reduces inflammation, pruritus, and other inflammatory symptoms

The addition of a corticosteroid to an antifungal agent can:

• Attenuate inflammatory symptoms rapidly
• Potentially increase patient compliance
• Reduce the risk of bacterial superinfection
• Enhance the efficacy of the antifungal agent 2

Appropriate Clinical Use

These combinations are most appropriate for:

• Inflammatory tinea infections (tinea corporis, tinea cruris, tinea pedis) with significant inflammation 3
• Short-term use only - therapy should not exceed 2 weeks for tinea cruris and 4 weeks for tinea pedis/corporis 3
• Adults with good compliance - combination products containing a low potency nonfluorinated corticosteroid may initially be used for symptomatic inflamed lesions in otherwise healthy adults 3

Important Limitations and Precautions

Contraindications

• Application on diaper or occluded areas
• Facial lesions
• Children under 12 years of age
• Immunosuppressed patients 3

Potential Adverse Effects

• Skin thinning and atrophy with prolonged use
• Telangiectasia
• Striae
• Masking of persistent infection
• Potential for deeper tissue invasion by fungi 3

Best Practice Recommendations

1. Start with combination therapy only for significantly inflamed fungal infections
2. Switch to a pure antifungal agent once inflammation subsides (typically within 7-14 days) 3
3. Avoid use on the face, groin, axillae, or under occlusion where steroid side effects are more likely
4. Confirm diagnosis before treatment - KOH preparation or culture is recommended when possible 1

Alternative Approaches

For cases where combination therapy is contraindicated:

• Use separate antifungal and corticosteroid products sequentially
• Consider antifungals with inherent anti-inflammatory properties (allylamines like terbinafine or ciclopirox olamine) 4
• For extensive or resistant cases, oral antifungal therapy may be considered 1

Clinical Pearls

• Some antifungal agents (particularly allylamines and ciclopirox olamine) possess inherent anti-inflammatory activity that may reduce the need for added corticosteroids 4
• Evidence shows combination antifungal/corticosteroid topicals are more expensive and potentially less effective than single-agent antifungals for long-term cure 5
• The risk of adverse effects increases with potent corticosteroids, occlusion, and prolonged use

Remember that while these combination products offer rapid symptomatic relief, they should be used judiciously and for limited periods to avoid potential complications from inappropriate corticosteroid use.