Fezioderm Cream
Composition
Each cream contains:
| Ofloxacin: | 0.75% w/w |
| Ornidazole: | 2% w/w |
| Itraconazole: | 1% w/w |
| Clobetasol propionate: | 0.05% w/w |
Inroduction
The largest organ of our body is skin. Skin is difficult to penetrate yet flexible and acts as a barrier to entry of foreign bodies1.
Microorganisms damage epidermis, dermis and subcutaneous tissues in Skin and soft-tissue infections (SSTIs) and result in inflammation.
Skin infections range from simple superficial infections to severe necrotizing infections. SSTIs may affect any part of the body2.
Compared to past decades, the incidence of SSTIs has dramatically grown supposedly due to the people living for longer time, increase in number of immune compromised persons, and the emergence of multi-resistant pathogens.
As dermatological infections become more common and complex due to changing epidemiologic and pathogenic characteristics, we have to develop new approaches to treatment.
Superficial fungal infections are widespread and they have typical appearance which helps their diagnosis.
Bacterial Infections:
Bacterial skin and soft tissue infections (SSTIs) are most common skin infections with about 20% of outpatient dermatology visits. Most SSTIs are caused by Staphylococcus aureus, with 50%of all SSTIs being caused by methicillin-resistant S. aureus (MRSA).
Gram-negative infections occur more commonly in children, diabetic patients or immunodeficient patients.
There are various bacterial skin infections that are common like cellulitis, erysipelas, impetigo, folliculitis, furuncles and carbuncles.
Cellulitis is defined as an infection of the dermis as well as subcutaneous tissue. The borders are demarcated and these infections are generally caused by Streptococcus or Staphylococcus.
Erysipelas are actually superficial form of cellulitis. They have clearly demarcated borders and predominantly caused by Streptococcus as a causative factor.
Impetigo is another type of skin infection caused by again Streptococcus or Staphylococcus. In impetigo, stratum corneum is raised slightly compared normal skin and results in blisters on the skin.
Folliculitis is an inflammation of the hair follicles and caused by Staphylococcus.
Furuncles is the skin infection where the infection of the follicle is much deeper.
Carbuncle is a stage when many more follicles are involved and opening and drainage may be required to treat the infection.
Fungal Infections
As more and more people get immunocompromised, the fungal infections are also increasing. Nonimmuno compromised patients, may also be prone for fungal infections though to less extent.
Fungal infections are difficult to treat. In case of skin and nail infections, application of the topical formulation to the affected area is recommended. Oral antifungal medicines are also recommended for serious infections.
The important fungi causing skin infections are the dermatophyte fungi (Trichophyton, Microsporum and Epidermophyton species) and the yeasts (Candida). Generally, the skin, hair and nails are affected by Dermatophytes. Yeast species typically affect the mucous membranes, but may also be responsible for infection of the skin and nails3.
Management of Skin and Soft Tissue Infections
First-line treatment of superficial fungal infections in the majority of cases is with topical agents as they avoid the potential side-effects of systemic treatments.
Polymicrobial infections involving both Gram-positive and Gram-negative organisms occur particularly where tissue vascular perfusion is compromised, such as diabetic foot infection or infection of ischemic or venous ulcers. Chronic infections, especially in patients previously treated with antibiotics, are likely to be polymicrobial with Gram-negative and anaerobic pathogens found alongside Gram-positive organisms.
Broad spectrum antibacterials, anaerobic antibacterials, antifungals, anti-inflammatory drugs like NSAIDs or corticosteroids are used in the treatment of skin and soft tissues.
Topical treatment is sufficient in most of the superficial infections. In addition, oral therapy is indicated for chronic infections, disabling or extensive disease, inpatients intolerant of or unresponsive to topical treatment, and in the immunocompromised.
Role of Ofloxacin
Antibacterial belonging to the Fluoroquinolones group like Ofloxacin that is active against gram-positive and gram-negative organisms is preferred. Other antibacterial recommended are penicillinase-resistant Penicillins, cephalosporins, or macrolides.
Role of Ornidazole
Ornidazole belongs to synthetic nitroimidazole group of drugs. It is used in the treatment of anaerobic bacteria which are found in skin and soft tissue infections. Ornidazole also helps in treating protozoal infections.
Role of Itraconazole
Itraconazole is an antifungal that has broad spectrum of coverage. Itraconazole is active against many pathogenic fungi like Dermatophytes, the infections are called tinea infections and infection with candida.
Itraconazole is highly effective in the treatment of inflammatory skin conditions like atopic eczema, seborrheic dermatitis or psoriasis due fungal infection.
Itraconazole has a primarily fungistatic activity. Itraconazole collects in the stratum corneum area of the skin and also in nails because of its keratin high affinity. Also, Itraconazole accumulates in sebum produced by skin and in vaginal mucosa.
Role of Clobetasol
Clobetasol is a topical corticosteroid used to treat swelling, itching and irritation of skin. Clobetasol is helpful in the treatment of skin conditions like eczema, including contact dermatitis, psoriasis, lichen planus lupus
Combination Therapy of Ofloxacin, Ornidazole, Itraconazole and Clobetasol
The combination of ofloxacin, ornidazole, Itraconazole & clobetasol propionate helps treat skin infections, inflammatory conditions and allergies. It will also help in relieving the itching, burning and scaling from the infections.
Packaging Information
15 gm tube
Usage
Apply as directed by your physician.
Warnings and Precautions
Do not apply the cream on the eyes, mouth, and nose.
References
- https://academic.oup.com/jac/article/65/suppl_3/iii35/922680
- https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0219-9
- https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.360
- Current Dermatology Reports (2020) 9:152–165
- Am Fam Physician, 2002;66:119-24
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