Clobetasol propionate with neomycin and nystatin

Source product: Clobetasol propionate/neomycin sulphate/nystatin 0.5 mg/5 mg/100,000 IU per g Cream (UK SPC §4.2). Clobetasol propionate belongs to the most potent class of topical corticosteroids (Group IV) and prolonged use may result in serious undesirable effects. As with other highly active topical steroid preparations, therapy should be discontinued when control is achieved — in the more responsive conditions this may be within a few days. DURATION: treatment should not be continued for more than 7 days without medical supervision; if a longer course is necessary, treatment should not be continued for more than 4 weeks without the patient's condition being reviewed, and if treatment with a local corticosteroid is clinically justified beyond 4 weeks a less potent corticosteroid preparation should be considered. Repeated but short courses may be used to control exacerbations; if continuous steroid treatment is necessary, a less potent preparation should be used. OCCLUSION: in very resistant lesions, especially with hyperkeratosis, anti-inflammatory effects can be enhanced if necessary by occluding the treatment area with polythene — overnight occlusion only is usually adequate, after which improvement can usually be maintained without occlusion. FACE: application to the face is undesirable (atrophic changes after prolonged treatment with potent topical corticosteroids); if used on the face, limit treatment to only a few days and do not use occlusion. ELDERLY: suitable for use in the elderly, with caution where renal function is decreased and significant systemic absorption of neomycin sulfate may occur; use the minimum quantity for the shortest duration to achieve the desired clinical benefit. PAEDIATRIC: suitable for use in children 2 years and over AT THE SAME DOSE AS ADULTS (no per-kg dose applies), but a course of treatment for a child should be limited to 5 days and occlusion should not be used — note that a child's napkin may act as an occlusive dressing. Not recommended for use in neonates and infants younger than 2 years (increased absorption through immature skin, immature renal function). Children may absorb proportionally larger amounts of topical corticosteroids and are more susceptible to systemic effects, including adrenal suppression, which can occur readily even without occlusion. Care should be taken to ensure the amount applied is the minimum that provides therapeutic benefit.