Choosing Wisely:

Avoid the use of combination topical steroid antifungals for tinea corporis, Candida skin infections, and diaper dermatitis.

Rationale and Comments: Although combination topical antifungal/corticosteroids have been approved for the treatment of tinea corporis, candidiasis, and diaper dermatitis, we recommend against use of these agents. Many providers are unaware that the combination products contain a relatively high-potency topical steroid. For treatment of tinea corporis, the application of a topical antifungal agent alone is recommended. If symptoms such as severe pruritus require concomitant application of a topical steroid, a separate low-potency agent can be prescribed, allowing for a tapering course that should be limited to less than two weeks. A separate topical antifungal cream can be continued longer until the infection is cleared. This will reduce the risk of systemic absorption of the topical steroid. Combination products are often used for treatment of diaper dermatitis. In most patients, diaper dermatitis is an irritant contact dermatitis from stool that will usually respond to barrier diaper creams/ointments alone. Combination products, if applied with every diaper change, can result in skin atrophy, striae, and systemic absorption of the relatively high-potency topical steroids. It is instead recommended that barrier products be applied with every diaper change in this circumstance and a second low-potency topical steroid be applied as needed, no more than twice a day and tapered as soon as the dermatitis is under control. Combination products are also often expensive and not covered by pharmacy plans.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Dermatology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Dermatologic
  • Pediatric
  • References: • Wheat CM, et al. Current trends in the use of two combination antifungal/corticosteroid creams. J Pediatr. 2017;186:192-195.
    • Cohen B. Differential diagnosis of diaper dermatitis. Clin Pediatr (Phila). 2017;56(5_suppl):16S-22S.
    • Alston SJ, et al. Persistent and recurrent tinea corporis in children treated with combination antifungal/corticosteroid agents. Pediatrics. 2003;111(1):201-203.

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