A potent, multi-ingredient topical combination preparation designed for the treatment of severe, complicated, or mixed dermatological infections with significant inflammation. It combines a super-potent corticosteroid (Clobetasol) with broad-spectrum antibacterial (Gentamicin), antifungal (Ketoconazole, Tolnaftate), and antibacterial/antifungal (Clioquinol) agents. This formulation is intended for short-term use in cases where infection and inflammation coexist, such as severe infected eczema, infected psoriasis, or extensive tinea corporis/cruris with secondary bacterial infection and inflammation.
Adult: Apply a thin film to the affected area once or twice daily, as directed by the physician. Duration should be limited, typically 1-2 weeks, and not exceeding 4 weeks.
Note: 1. Wash and dry the affected area thoroughly. 2. Take a small amount (pea-sized for an area the size of the palm) and apply a thin, even film. 3. Gently rub in until absorbed. 4. Wash hands after application unless hands are being treated. 5. Do not cover with occlusive dressings unless specifically advised by a doctor. 6. Avoid contact with eyes, nose, mouth, and other mucous membranes.
This combination exerts a multifaceted action: 1) Potent anti-inflammatory, immunosuppressive, and antipruritic effects via clobetasol. 2) Bactericidal action against Gram-negative and some Gram-positive bacteria via gentamicin. 3) Broad-spectrum antifungal and antibacterial action via clioquinol (effective against dermatophytes, Candida, and some bacteria). 4) Antifungal action against dermatophytes, yeasts (including Malassezia), and some Gram-positive bacteria via ketoconazole. 5) Specific antifungal action against dermatophytes via tolnaftate.
Pregnancy: Category C (US FDA). Topical corticosteroids, especially potent ones, can be absorbed in amounts sufficient to cause systemic effects. Animal studies show teratogenicity. Use only if potential benefit justifies potential risk to the fetus. Avoid large areas, prolonged use, or occlusive dressings.
Driving: No effect on driving ability.
| Other Topical Corticosteroids | Increased risk of local and systemic adverse effects. | Major |
| Systemic Corticosteroids (e.g., Prednisolone) | Additive systemic effects, increased risk of HPA axis suppression and Cushing's syndrome. | Major |
| Other Aminoglycosides (Systemic e.g., Amikacin) | Increased risk of ototoxicity and nephrotoxicity if gentamicin is systemically absorbed. | Moderate |
| Warfarin | Ketoconazole (if absorbed) inhibits CYP2C9/CYP3A4, potentially increasing INR and risk of bleeding. | Moderate |
| Statins (e.g., Simvastatin, Lovastatin) | Ketoconazole (if absorbed) inhibits CYP3A4, increasing statin levels and risk of myopathy/rhabdomyolysis. | Moderate |
| Drugs metabolized by CYP3A4 (e.g., Cyclosporine, Tacrolimus, Sirolimus) | Ketoconazole (if absorbed) can increase their plasma concentrations. | Moderate |
Same composition (Clobetasol (0.5mg) + Gentamicin (1mg) + Clioquinol (Iodochlorhydroxyquin) (10mg) + Ketoconazole (20mg) + Tolnaftate (10mg)), different brands: