Hydrozole: Another Poor OTC Combination Product
Sunday, January 31, 2010
Today I was again reminded how nonsensical some OTC combination products are. The thought was sparked by a prescription I received for Hydrozole(R). It's a non-PBS item and can be Pharmacist prescribed. Hydrozole is one of those annoying combination products; hydrocortisone 1% w/w and clotrimazole 1% w/w. According to television advertisements, of which there are many, it's apparently good for sensitive, inflamed skin conditions. I think it's crap, and most texts agree.
You see, if indeed the problem is a fungal infection then treatment, with an azole antifungal is required for 14 days after the lesion resolves (AMH, 2010). Moreover, if the 'rash' is eczematous and a steroid indicated, then a "5 days on, 2 days off" regimen is the usual treatment. Now, it's quite likely that an inflamed fungal infection occurs. And here's the kicker; at every pharmacy I work at, you can get both a steroid cream and an antifungal cream together for less than you pay for hydrozole.
What I suspect happens is that a prescriber is asked about a 'rash', and odds are, it's one of the two. Instead of suggesting the patient purchase one or t'other, they cover their bases and bow to he pressures of 6-minute medicine by writing a 'script; the prescriber's seen the TV adverts, too. I'd be impressed if most prescribers knew the cost of antifungals or steroid creams; I suspect most would pick the combination cream as less expensive. This presents an interesting challenge for those patients who "Just want what's on the prescription."
In short, hydrozole is a medicine that survives on its media profile. It's not appropriate for a simple fungal infection, excessive for an eczematous-type rash and cannot be used to treat anything for the appropriate time. Pretty much, there's no good reason to use Hydrozole(r) and even less reason to prescribe it.
You see, if indeed the problem is a fungal infection then treatment, with an azole antifungal is required for 14 days after the lesion resolves (AMH, 2010). Moreover, if the 'rash' is eczematous and a steroid indicated, then a "5 days on, 2 days off" regimen is the usual treatment. Now, it's quite likely that an inflamed fungal infection occurs. And here's the kicker; at every pharmacy I work at, you can get both a steroid cream and an antifungal cream together for less than you pay for hydrozole.
What I suspect happens is that a prescriber is asked about a 'rash', and odds are, it's one of the two. Instead of suggesting the patient purchase one or t'other, they cover their bases and bow to he pressures of 6-minute medicine by writing a 'script; the prescriber's seen the TV adverts, too. I'd be impressed if most prescribers knew the cost of antifungals or steroid creams; I suspect most would pick the combination cream as less expensive. This presents an interesting challenge for those patients who "Just want what's on the prescription."
In short, hydrozole is a medicine that survives on its media profile. It's not appropriate for a simple fungal infection, excessive for an eczematous-type rash and cannot be used to treat anything for the appropriate time. Pretty much, there's no good reason to use Hydrozole(r) and even less reason to prescribe it.
The worst is the parent thinks you're trying to upsell by adding on an azole. "The doctor didn't say anything to me about switching creams." I usually get around it by a combination of explaining the therapy, showing the manufacturer's instructions on the box of Hydrozole and asking them if they have any in-date Canesten or similar at home. (They never do, but seem glad to be asked.)
Hydrozole patients are always followed by new Yaz/Yasmin patients. "Yeah, my doctor told me they cost about $30."
Does this explain why they never bloody work?