Pediatricians could be overprescribing combination antifungal/corticosteroids

A review of a large claims-based database suggests that they are. Investigators identified almost 10,000 children aged up to 14 years who were prescribed either Lotrisone or Mycolog-II creams (antifungal and corticosteroid combination products) by pediatricians and other specialists from 2007 through 2014. Yet the US Food and Drug Administration does not recommend using Lotrisone in patients aged younger than 17 years and calls for limiting use of Mycolog-II, whose manufacture recently has been discontinued, to the “least amount compatible with an effective therapeutic regimen.”

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Pediatricians wrote the most prescriptions for the combination creams, usually for patients aged up to 14 years. Family medicine physicians were the second-heaviest prescribers. Dermatologists were least likely to prescribe these creams and pediatric dermatologists did not prescribe them at all. Prescriptions were most often associated with diaper rash, followed by contact dermatitis, rash and nonspecific skin eruption, and dermatophytosis (Wheat CM, et al. J Pediatr. 2017;186:192.e1-195.e1).

Thoughts from Dr Burke

Citing long-standing evidence of bad outcomes in the dermatology literature, these dermatologist authors give the following advice to pediatricians: “We recommend against the use of combination antifungal/corticosteroid creams because of the greater cost, lower efficacy, and greater risk of adverse effects.” I will follow their advice.