Pediatrics Jan. Now available generically, the product is still popular among primary care physicians despite its adverse effects and relatively poor efficacy. More than half of the prescriptions written are for children younger than 4 years. Investigators retrospectively reviewed 6 cases of children with persistent tinea corporis unresponsive to CBD cream. The 6 children were identified from a review of all cases of children aged 4 to 11 years who had been treated over a 6-month period at a single university-based clinic.
All 6 had been diagnosed with tinea corporis by their primary care physicians and treated unsuccessfully with multiple courses of CBD cream over periods of 2 to 12 months. Positive potassium hydroxide preparations subsequently confirmed the diagnoses. All but 1 child had tinea faciei. Cure was defined as clinical clearing that persisted for at least 1 month after cessation of medication. All patients were cured with single-agent therapy: 4 with topical medication and 2 with griseofulvin.
Wheat and her associates said. In a study of 9, patients aged years who were prescribed either Lotrisone or Mycolog-II creams from to , pediatricians were most likely to prescribe the combination creams mean, patients , followed by family physicians mean, patients , and dermatologists mean, 49 patients. No pediatric dermatologists prescribed either cream.
Sometimes a fungal infection induces an inflammatory dermatitis. In these cases the use of both an antifungal and a corticosteroid with careful monitoring can benefit the patient, the researchers said. Also, in , Lotrisone was approved by the FDA for treating tinea corporis, tinea pedis, and tinea cruris in patients older than 12 years.
However, lack of efficacy and severe adverse effects including hypothalamic-pituitary-adrenal axis suppression, Cushing syndrome, hyperglycemia, hirsutism, delayed growth, and skin atrophy led the FDA to recommend that Lotrisone not be prescribed for patients younger than 17 years and not be prescribed to treat diaper dermatitis.
Wheat and her associates recommend a single-agent topical antifungal to treat superficial fungal infection. If there is intense itching due to infection-induced dermatitis, add a low- or medium-potency topical corticosteroid for just days. For diaper dermatitis with a confirmed secondary fungal infection, they recommend a topical antifungal agent in combination with a barrier cream.