Hydrocortisone with chlorhexidine and nystatin

How it works

Hydrocortisone reduces local inflammation via glucocorticoid receptors, chlorhexidine disrupts bacterial cell membranes, and nystatin binds ergosterol to create membrane pores that kill Candida.

Prescribing in practice

• Reserve the steroid-containing combination for inflamed skin with confirmed or strongly suspected candidal and bacterial involvement, and use short term to avoid steroid-related skin atrophy in flexures and the nappy area.
• Nystatin treats Candida but is inactive against dermatophytes, so confirm the infecting organism.
• Avoid on broken skin where chlorhexidine absorption or irritation may be increased.

Monitoring

Review the treated area for resolution of both inflammation and infection and step down the steroid once settled.

Counselling the patient

• Apply thinly to the affected folds and keep the area clean and dry.
• Use only for the short period advised, not as a long-term cream.
• Return if the rash spreads or does not improve.

Evidence & guidelines

Combined topical steroid-antimicrobial products are reserved for inflammatory dermatoses with secondary infection, consistent with standard prescribing references.