Version May 2024
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.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Clioquinol and hydrocortisone: Pediatric drug information")
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.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported with combination product; frequency not defined.
Dermatologic: Allergic skin reaction, dyschromia, epidermal thinning, hair discoloration, skin rash
Hematologic & oncologic: Nonthrombocytopenic purpura
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.
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.
Topical corticosteroids may be absorbed percutaneously. The extent of absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur, particularly in younger children or in patients receiving high doses for prolonged periods; acute adrenal insufficiency (adrenal crisis) may occur with abrupt withdrawal after long-term therapy or with stress. Infants and small children may be more susceptible to HPA axis suppression or other systemic toxicities due to larger skin surface area to body mass ratio; use with caution in pediatric patients. Monitor closely for adverse effects in patients who require longer duration of therapy (>14 days), a dosing frequency of 3 to 4 times daily, application to >5% to 10% of body, or use of an occlusive dressing.
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 [DSC]) [contains cetyl alcohol, polysorbate 80]
No
Cream (Ala-Quin External)
3-0.5% (per gram): $17.95
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
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.
Topical: For external use only; avoid contact with eyes. Apply a thin film to clean, dry skin and rub in gently. May stain skin, hair, nails, and fabric. Wash hands after application unless site of treatment.
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.
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
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. Risk C: Monitor therapy
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).
Systemically administered corticosteroids are excreted in breast milk and endogenous hydrocortisone is also found in human milk. It is not known if systemic absorption following topical administration results in detectable quantities in human milk. Use with caution while breast-feeding; do not apply to nipples (Reed, 1997).
Observe affected area for increased irritation; growth in children.
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
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