title: Pediatricians who prescribe clotrimazole-betamethasone diproprionate (Lotrisone) often utilize it in inappropriate settings regardless of their knowledge of the drug's potency.
abstract: Clotrimazole-betamethasone diproprionate (C-BMV) is a fluorinated, high potency topical steroid that has been formulated with clotrimazole in the brand-named product, Lotrisone. The product is frequently used inappropriately in intertriginous areas, particularly in children. The following evaluates the use of this combination based upon a survey of 106 US-based pediatricians with at least two years post-residency, who attended the 1999 American Academy of Pediatrics. Of pediatricians who prescribe C-BMV, 23% prescribe it for diaper dermatitis. 11% of C-BMV prescriptions exceed the recommended duration of therapy. Only 18% of prescribing pediatricians correctly identify "Lotrisone" as a high potency steroid. There is no significant association between knowledge of C-BMV potency and frequency of use (p>.1). These self-reported data confirm and complement the findings of previous studies that used representative national data to assess the use of C-BMV. Pediatricians continue to utilize C-BMV in inappropriate settings, such as diaper dermatitis, regardless of their knowledge of the agent's potency. Our advice is to refrain from using high-potency steroids, such as C-BMV, in pediatric cases as there are more appropriate, safer alternatives with many fewer side effects.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine.
authors.forename: Divya
authors.initials: D
authors.lastname: Railan
authors.forename: Jill K
authors.initials: JK
authors.lastname: Wilson
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000627:therapeutic use*; D002179:Candidiasis, Cutaneous / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003022:Clotrimazole / Q000627:therapeutic use*; D000075202:Contraindications; D003872:Dermatitis / Q000188:drug therapy / Q000209:etiology; D003881:Dermatomycoses / Q000188:drug therapy; D003963:Diaper Rash / Q000188:drug therapy; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004363:Drug Utilization / Q000639:trends; D005938:Glucocorticoids; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000193:education; D011364:Professional Practice; D011795:Surveys and Questionnaires
chemical_list: D000891:Anti-Infective Agents, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D005938:Glucocorticoids; C452620:Lotrisone; D001623:Betamethasone; D003022:Clotrimazole