Imacort

Imacort is a corticosteroid used in dermatology in combination therapy.

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Indications Imacorta

Shown in the following situations:

• in infectious processes in the skin (especially those caused by Candida fungi or dermatophytes) with a severe degree of inflammation;
• infected form of eczema or the risk of its infection (for example, against the background of seborrheic dermatitis);
• inflammatory form of mycosis (this especially concerns mycosis in the foot area);
• candidiasis in the groin area or in skin folds;
• superficial type of pyoderma.

Release form

It is produced in the form of a cream in 20 g tubes. One package contains 1 tube of cream.

Pharmacodynamics

The drug has anti-allergic, anti-inflammatory, and anti-exudative properties (the effect of prednisolone), and along with this, a wide range of antifungal effects (clotrimazole), enhanced by the action of hexamidine, which extends the effect of the drug to gram-negative and gram-positive pathogens.

Clotrimazole has antimycotic activity, which is provided by slowing down the processes of biosynthesis of the substance ergosterol, which is part of the fungal cell membrane. The range of action of the substance includes dermatophytes (such as Trichophyton mentagrophytes, Trichophyton rubra and other fungi of the genus Trichophyton; flocculent epidermophyton and fungi of the genus Microsporum), yeast fungi (of the genus Trichosporon and Candida (including Candida albicans)) and mold (for example, of the genus Aspergillus). The substance has an antimicrobial effect on individual gram-positive microbes (streptococci, staphylococci, Proteus vulgaris), and at the same time against Corynebacteria and Nocardia.

Hexamidine diisothionate enhances the properties of clotrimazole, especially against Candida fungi, and also expands the range of its action, including gram-negative microbes, which are an important part of the development of infections in mycosis of the feet.

Prednisolone is a non-halogenated, relatively weak GCS (1st category of strength), which, in addition to the above properties, is able to relieve itching. Due to the combination of a corticosteroid and a disinfectant, it reduces the sensitivity of the skin and its inflammation, and along with this, the sensation of itching during the development of mycosis. In addition, such a combination helps protect inflamed skin from secondary infections, to which the skin becomes susceptible due to the use of GCS.

The product is based on a hydrophilic, slightly fatty emulsion of the form "oil-in-water". It is excellent for eliminating subacute and acute forms of pathology.

Pharmacokinetics

No studies have been conducted on the absorption or penetration of the above-mentioned combination of components into the body. There is information in the literature that after local application of clotrimazole, the substance reaches the concentrations necessary for bactericidal action in the deep skin layers, and the level sufficient for bacteriostatic action is within the dermis.

The absorption rate is very low (<5%), and with hermetically sealed clotrimazole (0.8 g dosage), the plasma value is below the minimum detection limit of 0.001 μg/ml. This allows systemic absorption to be ignored.

The action of hexamidine diisothionate is mainly superficial, the substance is capable of approximately 90-100% concentration inside the stratum corneum of the skin after a long period of use. About 0.03-0.1% of the applied component can be found inside the upper layers of the dermis or in the epidermis. Inside the lower layers of the dermis, this element is almost not detected. Effective medicinal indicators were observed inside the layers at the level of skin ridges. Absorption under the skin is low - inside healthy skin it is equal to 0.009-0.017%, and in injured skin - 0.071% of the applied substance in 48 hours.

The absorption rate of prednisolone without the use of occlusion is 1-2%.

The passage of corticoids can be increased by using hermetic dressings or with diaper rash of the skin. The weakened protective function of the stratum corneum largely contributes to this. As a result, the passage of the substance prednisolone acetate depends on the age of the person, the location of the injury, the condition of the skin, the form of the drug used, and the method of applying the dressing.

Dosing and administration

Imacort should be applied twice a day to inflamed areas and adjacent areas. Before performing the procedure, the skin should be thoroughly washed and dried.

To eliminate mycosis, a long course is required; for candidiasis, it is no more than 2 weeks, and to eliminate infectious processes caused by dermatophytes, a maximum of 6 weeks is required.

After the inflammatory process has been stopped, it is necessary to continue treatment using a similar disinfectant drug, but one that does not contain corticosteroids.

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Use Imacorta during pregnancy

The medicine should not be prescribed to pregnant women. When used during lactation, breastfeeding should be discontinued.

Contraindications

Among the contraindications:

• hypercorticism syndrome, tuberculosis, chickenpox, luetic infectious processes (or those caused by a virus) within the skin;
• in addition, common herpes, the period of vaccination and the presence of local reactions to it, skin ulcers or tumors, scabies, trophic ulcers, and along with this, rosacea, acne, as well as perioral dermatitis;
• the cream cannot be used if there is an intolerance to the active components of the drug or other antifungal drugs of the imidazole group;
• It is prohibited to prescribe it for the elimination of infectious processes on the scalp, as well as for the treatment of nails;
• not prescribed for children.

Side effects Imacorta

The following side effects may develop as a result of using the cream.

Subcutaneous tissue, as well as skin: intolerance to the active components of the drug, as well as any of the auxiliary elements, is not excluded. In case of such a reaction, it is necessary to cancel the use of the drug. A hypersensitivity reaction to clotrimazole can manifest itself in the form of the following symptoms: burning, irritation, redness and itching with swelling on the skin. In addition, watery blisters, blisters, peeling, rashes, pain and discomfort. Fever or urticaria may appear, and along with this, allergic manifestations (such as dyspnea, fainting and decreased blood pressure).

Hexamidine can cause sensitization, the risk of which increases depending on the increase in the severity of skin lesions. The contact type of dermatitis provoked by the drug is associated with the Arthus phenomenon, which may be a sign of the involvement of humoral immunological reactions in this process. At the same time, the clinical signs of the disease often differ from standard contact eczema: rashes mainly with infiltrates, vesicular or papular formations in the form of a hemisphere can be seen on the skin, which are grouped in one place or isolated from each other. There are so many of them in the areas of application of the disinfectant that they can even merge with each other. Usually, such a rash passes very slowly. Systemic allergic reactions may also occur after local use.

Local reactions to corticosteroids may occur - swelling, rashes, hyperemia, urticaria and purpura in the treatment area. In addition, burning, dryness, irritation and itching may occur. After prolonged use of the cream, atrophy or telangiectasia often develops, stretch marks, steroid-type acne, bleeding, perioral dermatitis similar to rosacea, and hypertrichosis appear. Prolonged use of the cream can cause secondary infectious processes in the skin.

Endocrine system: as a result of long-term application to large areas of the body, systemic effects may develop. Among the disorders: inhibition of internal synthesis of corticosteroids, hypercorticism with edema, atrophic stretch marks, development of latent diabetes mellitus, and also osteoporosis, as well as growth retardation in children. But the development of such symptoms is almost impossible for weak corticosteroids, which include prednisolone acetate.

The medicine contains butylhydroxyanisole (or E 320), which can provoke local skin reactions (for example, contact dermatitis) or irritation of the eyes and mucous membranes.

Interactions with other drugs

Prednisolone can reduce the activity of other steroid antibiotics used locally. Among these are fusidic acid and chemotherapy drugs made from quaternary ammonium.

Local application of clotrimazole may produce antagonistic effects relative to amphotericin or other antibiotics with a broad spectrum of action.

During the therapeutic course, it is forbidden to vaccinate against smallpox or carry out other immunization procedures, since glucocorticoids have immunosuppressive properties.

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Storage conditions

The cream must be kept in a place inaccessible to children, and at a temperature of no more than 25°C.

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Shelf life

Imacort is suitable for use for 3 years from the date of release of the drug.