title: Prescription of high-potency corticosteroid agents and clotrimazole-betamethasone dipropionate by pediatricians.
abstract: Family physicians, internists, and pediatricians are more likely to prescribe combination topical antifungal-topical corticosteroid preparations than are dermatologists. One such preparation, clotrimazole-betamethasone dipropionate, can cause atrophy because it has a high-potency corticosteroid component. We analyzed data from the National Ambulatory Medical Care Survey for visits to pediatricians from 1990 to 1994 and isolated visits at which a topical corticosteroid agent or clotrimazole-betamethasone dipropionate was prescribed. Pediatricians rarely prescribed single-agent, high-potency topical corticosteroid agents in managing patients with skin disorders. High-potency corticosteroid agents accounted for 5.0% of topical corticosteroid prescriptions, whereas 56.3% were low-potency and 38.7% were medium-potency agents. Of the 696,285 mentions of clotrimazole-betamethasone dipropionate, 56.4% (389,920) were for children aged newborn to 4 years; diagnoses were erythematodesquamatous dermatoses, diaper rash, tinea, well-baby visit, and candidiasis. In contrast, for dermatologists nationwide, no drug mention existed for this combination agent for children aged newborn to 4 years over the 5-year study period. Our results show that clotrimazole-betamethasone dipropionate is prescribed inappropriately by pediatricians, especially in the treatment of young children. Pediatricians rarely use high-potency topical corticosteroid agents, but most of their use of clotrimazole-betamethasone dipropionate is in the youngest children, in whom such corticosteroid use is least appropriate. This prescription pattern suggests that some pediatricians may be unaware that clotrimazole-betamethasone dipropionate has a high-potency cortico steroid component.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002675:Child, Preschool; D003022:Clotrimazole / Q000627:therapeutic use*; D004363:Drug Utilization; D005938:Glucocorticoids; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012871:Skin Diseases / Q000188:drug therapy*
chemical_list: D000891:Anti-Infective Agents, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D003022:Clotrimazole