Common Topical Antifungal with Steroid Combinations
Clotrimazole 1% with betamethasone dipropionate 0.05% (Lotrisone) is the most widely prescribed topical antifungal-corticosteroid combination. 1
Overview of Antifungal-Steroid Combinations
Topical antifungal-corticosteroid combinations are frequently used in clinical practice to simultaneously treat fungal infections while managing associated inflammation and pruritus. These combinations offer several advantages:
- They provide dual action by treating the fungal infection while reducing inflammation and relieving itching 2
- Common combinations include antifungals (miconazole or terbinafine) with corticosteroids of varying potencies 2
- They can help prevent scratching that might otherwise accelerate skin damage and spread the infection 2
Commonly Used Combinations
- Clotrimazole 1%/betamethasone dipropionate 0.05% (Lotrisone) - one of the most widely prescribed combinations 1
- Nystatin/triamcinolone acetonide (Mycolog-II) - another commonly used combination 3
- Miconazole with various corticosteroids 2
- Terbinafine with various corticosteroids 2
Indications and Limitations
Clotrimazole/betamethasone dipropionate (Lotrisone) is FDA-approved for:
- Treatment of tinea pedis, tinea cruris, and tinea corporis in adults and children over 12 years of age 1
- Treatment duration is limited to 2 weeks in the groin area and 4 weeks on the feet 1
Cautions and Concerns
While these combinations can be effective, there are important considerations:
They may be less effective than antifungal monotherapy for clearing certain infections, particularly candidal and Trichophyton infections 1
They are more expensive than using antifungal agents alone 1, 3
Incorrect use may be associated with treatment failure and adverse effects 4
Concerning adverse effects have been reported in children, including:
- Treatment failure
- Striae distensae (stretch marks)
- Hirsutism
- Growth retardation 1
Persistent or recurrent tinea corporis (especially tinea faciei) has been observed in children initially treated with combination antifungal/corticosteroid creams 5
Prescribing Patterns
- Primary care physicians tend to prescribe combination products more frequently than dermatologists 1
- In one study, Lotrisone accounted for over 50% of topical antifungal expenditures as prescribed by primary care physicians, but only 7% of topical antifungals prescribed by dermatologists 1
Recommendations for Use
- These combinations should be used judiciously in the treatment of cutaneous fungal infections 1
- They may not be appropriate for use in children due to potential steroid-related side effects 1
- Consider using them primarily for short-term management of inflammatory fungal infections 4
- For long-term management, transition to antifungal monotherapy once inflammation subsides 4
When inflammation is a significant component of a fungal infection, a topical antifungal-corticosteroid combination may be appropriate for short-term use, but clinicians should be aware of the potential limitations and adverse effects, particularly in pediatric populations.