Clobetasol propionate with neomycin and nystatin

How it works

Clobetasol suppresses cutaneous inflammation via glucocorticoid receptors, neomycin is bactericidal by inhibiting bacterial protein synthesis, and nystatin binds fungal ergosterol to kill Candida.

Prescribing in practice

• Combining a very potent steroid with an antibacterial and antifungal risks both steroid-induced skin atrophy/systemic absorption and neomycin contact sensitisation, so it should be reserved for short courses where infection genuinely complicates inflammation.
• Avoid prolonged or large-area use, and limit application near the ears as topical neomycin carries a theoretical risk of ototoxicity if absorbed through broken skin or large areas.
• Avoid use on the face and flexures where possible and do not apply to extensive raw or denuded skin.

Monitoring

Review the treated skin regularly for atrophy, sensitisation and treatment response, and stop if the infection or inflammation fails to improve.

Counselling the patient

• Apply thinly to affected areas only and use for no longer than directed.
• Stop and seek advice if the rash worsens or new redness, itch or swelling develops, which may indicate allergy to the antibiotic.

Evidence & guidelines

Combined potent steroid-antimicrobial preparations are recommended only for short-term use in infected inflammatory dermatoses; neomycin sensitisation is a well-recognised limitation.