Dose:    Apply thin layer topically

Frequency:  Q  12 hours topically

Comments:  Clotrimazole is both fungicidal and fungistatic (Candida, Trichophyton, Microsporon, and Epidermophyton species and Malassezia furfur) but has no effect on bacteria, protozoa, or viruses. Primarily used to treat candida skin infections. Clotrimazole is not absorbed from the skin. Betamethasone can be absorbed and is metabolized in the liver.  Clotrimazole has been used in several small studies for the treatment of cutaneous candidiasis. Response rates of 80% to 100% have been reported. It was found to be as effective as nystatin ointment or cream (Pediatr Infect Dis J 1997; 16:885). It has been demonstrated that the clotrimazole-steroid combination provides better benefit than the clotrimazole component alone during the first few days of treatment for tinea pedis or tinea corporis. Do not use for longer than 14 days. Do not use with occlusive dressings.   The lotion contains benzyl alcohol so that the cream should only be used. The use of Lotrisone cream is not recommended by the manufacturer for treatment of Candida diaper dermatitis because of concern that the diaper will function as an occlusive barrier increasing absorption of the steroid.

Toxicity:No adverse effects reported for clotrimazole. Topical steroids can cause burning, itching, dryness, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, secondary infections, and skin atrophy. Absorption of topically applied steroids can occur if used over large areas for prolonged periods of time and if occlusive dressings are used. This has been reported to be more likely to occur in infants and children. This could lead to suppression of the hypothalamic-pituitary- adrenal axis as well as producing symptoms of Cushing syndrome. In addition, intracranial hypertension has been reported to occur following significant systemic absorption. The above is extremely unlikely if used sparingly, or a twice daily schedule.

Preparation: Clotrimazole and betamethasone (Lotrisone) is available in 15 and 45 gram tubes which contain clotrimazole 10 mg/gram and betamethasone 0.64 mg/gram. Store at room temperature. Avoid freezing. Clotrimazole 1% cream (Lotrimin) is also available without the betamethasone in 15, 30, and 45 gram tubes.