What are the implications of clotrimazole-betamethasone dipropionate for nonfungal skin conditions?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, September 1, 2024
In this month’s Clinical Applications column, DermWorld Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Avrom S. Caplan, MD, FAAD, and Jeremy A. W. Gold, MD, MS, about their JAMA paper ‘Clotrimazole-Betamethasone Dipropionate Prescribing for Nonfungal Skin Conditions.’
DermWorld: Your study found that less than one-third of adults prescribed with clotrimazole-betamethasone received a fungal diagnosis. What factors do you think are influencing the choice of clotrimazole-betamethasone over other treatment options for suspected fungal infections, especially in cases lacking a confirmed fungal diagnosis?
DermWorld: Your study notes that dermatologists prescribed clotrimazole-betamethasone less frequently compared to other specialties. Who is prescribing this combination treatment?
Drs. Caplan and Gold: That’s correct. Most often, it was non-dermatologists who prescribed clotrimazole-betamethasone. In our study, most prescriptions for clotrimazole-betamethasone were from family practice or internal medicine physicians, followed by OB-GYNs. We think there’s an opportunity here for dermatologists to educate their colleagues in other fields about the importance of confirming fungal infections with diagnostic testing whenever possible and referring patients to a dermatologist when the diagnosis is uncertain. As an alternative to combination antifungal-corticosteroid products, clinicians could consider prescribing antifungal monotherapy, which can help decrease inflammation and associated itching.
DermWorld: What are the potential implications of non-dermatologist physicians (or others) prescribing this medication, particularly regarding the use of high-potency corticosteroids and implications for patient safety and antimicrobial resistance?
Drs. Caplan and Gold: We hope that our study can raise awareness among all types of physicians and non-physician health care providers about the importance of confirming suspected fungal skin infections with diagnostic testing. Primary care providers are likely to be the first to encounter patients with suspected fungal skin infections. Increasing access to diagnostic testing is going to be difficult, but this can help ensure that patients receive the correct treatment for their skin condition and can help prevent the misuse and overuse of topical antifungals (particularly antifungal-corticosteroid products).
DermWorld: Based on the findings, what educational/policy initiatives could mitigate inappropriate prescribing of clotrimazole-betamethasone, especially in populations where its use is more likely to cause harm?
Drs. Caplan and Gold: We think there’s an opportunity here for dermatologists to educate their colleagues in other fields about the importance of confirming fungal infections with diagnostic testing whenever possible and referring patients to a dermatologist when the diagnosis is uncertain. We hope that these findings can help encourage dermatologists to make other health care professionals aware of alternatives to combination antifungal-corticosteroid products. Clinicians can consider prescribing antifungal monotherapy, which can help decrease inflammation and associated itching.
Avrom S. Caplan, MD, FAAD, is assistant professor of the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, and co-director of the Sarcoidosis Program.
Jeremy A. W. Gold, MD, MS, is a medical epidemiologist at the Centers for Disease Control and Prevention.
The authors do not have any relevant financial and/or commercial conflicts of interest. Their paper appeared in JAMA.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
Want to read more?
Check out the most popular Clinical Applications columns.
