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Clioquinol and Hydrocortisone

Medically reviewed by Drugs.com. Last updated on Jul 25, 2020.

Pronunciation

(klye oh KWIN ole & hye droe KOR ti sone)

Index Terms

  • Hydrocortisone and Clioquinol
  • Hydrocortisone and Iodochlorhydroxyquin
  • Iodochlorhydroxyquin and Hydrocortisone
  • Iodochlorhydroxyquinoline and Hydrocortisone

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Ala-Quin: Clioquinol 3% and Hydrocortisone 0.5% (28.4 g); Clioquinol 3% and hydrocortisone 0.5% (80 g) [contains cetyl alcohol, polysorbate 80]

Kit, External:

Dermasorb AF: Clioquinol 3% and hydrocortisone 0.5% [DSC] [contains cetyl alcohol, polysorbate 80, propylene glycol]

Brand Names: U.S.

  • Ala-Quin
  • Dermasorb AF [DSC]

Pharmacologic Category

  • Antibiotic, Topical
  • Antifungal Agent, Topical
  • Corticosteroid, Topical

Pharmacology

Clioquinol is a broad spectrum antibacterial and antifungal agent; hydrocortisone is a corticosteroid that decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.

Absorption

Topical corticosteroids are absorbed percutaneously. The extent is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, and the use of occlusive dressings

Metabolism

Hepatic

Excretion

Urine, bile

Use: Labeled Indications

Dermatologic disorders: Acute and chronic dermatologic disorders including contact or atopic dermatitis; impetiginized eczema; nummular eczema; infantile eczema; endogenous chronic infectious dermatitis; stasis dermatitis; pyoderma; nuchal eczema and chronic eczematoid otitis externa; acne urticata; localized or disseminated neurodermatitis; lichen simplex chronicus; anogenital pruritus (vulvae, scroti, ani); folliculitis; bacterial dermatoses; mycotic dermatoses such as tinea (capitis, cruris, corporis, pedis); moniliasis; intertrigo.

Contraindications

Hypersensitivity to iodochlorhydroxyquin, hydrocortisone, chloroxine, iodine, iodine-containing preparations, or related compounds; eye lesions; tuberculosis of the skin; herpes simplex, vaccinia, eczema vaccinia, varicella, or other viral infections of the skin.

Canadian labeling: Additional contraindications (not in US labeling): Syphilitic skin infections; application to large areas, ulcerated areas, or to the eye; children <2 years.

Dosing: Adult

Dermatologic disorders: Topical: Apply a thin film 2 to 4 times daily.

Vioform Hydrocortisone [Canadian product]: Apply a thin film 2 to 3 times daily.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Adjust dose depending upon condition being treated and response of patient. The lowest possible dose should be used to control the condition; when dose reduction is possible, the dose should be reduced gradually.

Dermatologic disorders:

Children ≥2 years and Adolescents: Clioquinol 3%/hydrocortisone 0.5% cream: Topical: Apply a thin film to affected area 2 to 4 times daily.

Canadian labeling: Vioform Hydrocortisone (clioquinol 3%/hydrocortisone 1%) cream: Topical: Children ≥2 years and Adolescents: Apply a thin film 2 to 3 times daily.

Administration

Topical: For external use only; avoid contact with eyes. Apply a thin film to clean, dry skin and rub in gently. Can stain skin and fabric. Use of occlusive dressings is not recommended.

Storage

Store at 20°C to 25°C (68°F to 77°F); protect from freezing.

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Calcipotriene: Hydrocortisone (Topical) may diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with hydrocortisone valerate. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Monitor therapy

Test Interactions

Thyroid function tests; false-positive ferric chloride test for phenylketonuria.

Adverse Reactions

Reported with combination product; frequency not defined.

Dermatologic: Allergic skin reaction, dyschromia, epidermal thinning, hair discoloration, skin rash

Hematologic & oncologic: Nonthrombocytopenic purpura

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• Sensitization: Topical use has been associated with irritation (rare); discontinue use if irritation occurs.

• Superinfection: Prolonged use may result in overgrowth of nonsusceptible organisms requiring appropriate therapy.

• Staining: May stain skin and fabrics; may discolor (yellowing) hair and fingernails (rare).

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, and/or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Renal impairment: Use with caution in patients with renal impairment.

• Thyroid disease: Use caution in patients with thyroid disease.

Special populations:

• Pediatric: Topical application poses a potential risk of toxicity to infants and children; striae has been reported with use of some corticosteroids in infants and children. Children may absorb proportionally larger amounts of corticosteroids after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Other warnings/precautions:

• Appropriate response: Re-evaluate patient if no response within 1 to 2 weeks.

• Appropriate use: Avoid use on large or eroded areas, use for >1 week, and use of occlusive dressings.

Monitoring Parameters

Observe affected area for increased irritation; growth in children.

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed with corticosteroids in animal reproduction studies. Topical products are not recommended for extensive use, in large quantities, or for long periods of time in pregnant women (Reed, 1997).

Patient Education

What is this drug used for?

• It is used to treat skin infections.

• It is used to treat skin irritation.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Burning

• Dryness

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• High blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit

• Adrenal gland problems like very bad upset stomach, throwing up, very bad dizziness, passing out, muscle weakness, feeling very tired, mood changes, not hungry, or weight loss

• Cushing's disease like weight gain in upper back or abdomen; moon face; severe headache; or slow healing

• Skin changes like acne, stretch marks, slow healing, or hair growth

• Skin thinning

• Application site irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.