![]() ![]() The Taskforce had recommended the DCGI to bring topical steroids under schedule-H to include schedule-H1 warning on package insert for potent topical corticosteroid and to immediately enforce ban on all the irrational FDCs of topical corticosteroids with antifungal, antibacterial, and skin-lightening agents. To stop the irrational use of topical corticosteroids, the Indian Association of Dermatologist, Venereologist, and Leprologist (IADVL) took an initiative to form a special task force called IADVL Taskforce against Topical Steroid Abuse. The expert consensus from India has also strongly discouraged the use of topical corticosteroids in the management of dermatophytosis. While there may be a scientific merit in using topical corticosteroids with antifungal agent for a fungal infection, adding antibiotics in a preparation meant for treating fungal infection cannot be justified. These FDCs are therefore not routinely recommended unless there is a heavy inflammatory component in an otherwise healthy adult with good compliance and severe symptoms, which is causing impairment in daily activities. also reported a 3–4 times higher relapse rates and adverse drug reactions with clotrimazole/betamethasone dipropionate cream as compared to naftifine alone. showed a mycological cure rate of 73% with naftifine and only 43% with the steroidal FDC, at 4 weeks of treatment. A double-blind comparison of naftifine cream and clotrimazole/betamethasone dipropionate cream in the treatment of tinea pedis by Smith et al. Ketoconazole 2% + fluocinolone acetonide 0.1% + neomycin 0.5% (E-F)Įvidence from well-controlled studies suggests that the use of steroid-antifungal combination is not superior to a single antifungal agent and has lower mycological and clinical cure rates in the management of dermatophytosis. Ketoconazole 2% + clobetasol proprionate 0.05% + neomycin 0.5% + tolnaftate 1% (D) Ketoconazole 2% + clobetasol proprionate 0.05% + neomycin 0.5% (C) Ketoconazole 2% + clobetasol proprionate 0.05% + gentamycin 0.1% + tolnaftate 1% (B) ![]() Ketoconazole 2% + clobetasol proprionate 0.05% +gentamycin 0.1% (A) Terbinafine 2% + clobetasol proprionate 0.05%+ ciprofloxacin 1% + metronidazole 1% (G-H) Terbinafine 2% + clobetasol proprionate 0.05% + ofloxacin 0.75% + ornidazole 2% (A-F) Miconazole 2% + beclomethasone 0.025% + neomycin 0.5% (J-K)Ĭlotrimazole 1% + beclomethasone 0.025% + neomycin 0.5% (A-G)Ĭlotrimazole 1% + beclomethasone 0.025% + gentamycin 0.1% (H-J)Ĭlotrimazole 1% + betamethasone 0.05% + gentamycin 0.1% (K) Miconazole 2% + clobetasol proprionate 0.05% + gentamycin 0.1% (H-I) Miconazole 2% + clobetasol proprionate 0.05% + neomycin 0.5% (A-G) Topical FDCs of antifungal agenst with corticosteroids These formulations account for over half of the sales of all topical steroids in the Indian market. Some of these steroid-antifungal cocktails cost lesser than the pure antifungal creams, provide quick symptomatic relief, and are easily available over the counter which makes them popular. People stop their use as the itching and redness disappear and reuse as symptoms remerge. These steroid cocktails are often used by patients as self-medication, for symptomatic relief without supervision by a trained specialist. In India, FDC creams containing steroid, antifungal, and antibacterial cocktails are easily available over the counter. Recently, the prevalence of superficial dermatophytosis has seen an alarming rise and ranges from 36.6% to 78.4% in different regions of India, and the present situation has been described by some experts as the “Great Indian Epidemic of Superficial Dermatophytosis.” Indiscriminate use of fixed-drug combination (FDC) of corticosteroids with one or more antifungal and antibacterial agents has been cited as a major reason for the emergence of chronic, atypical, recurrent, recalcitrant, and treatment-resistant cases of superficial dermatophytosis in epidemic proportion. Superficial dermatophytosis, commonly known as ringworm or tinea, is a common fungal infection affecting over 20% of the population worldwide. ![]()
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