Nystatin is placed under the category of anti-infective medicines in the WHO Model List of Essential Medicines, a list that includes safe, cost-effective drugs that are considered indispensable for a basic healthcare system.Marketed under different brand names such as Quenalog, Mykacet, and Mytrex, nystatin and triamcinolone acetonide is a combination drug. It is available in the form of a cream or an ointment for topical use. Prescribed only for external or dermatologic use, this cream is recommended for individuals affected by skin infections caused by a fungus or yeast. Besides inhibiting the growth of fungi or yeast, it also helps reduce inflammation. Though it is nystatin that exhibits antifungal activity, it has been observed that the nystatin and triamcinolone combination is more beneficial for treating cutaneous candidiasis than the use of nystatin alone.
It must be noted that the use of this drug is contraindicated in some cases. The FDA has placed it in the pregnancy category C. This means that there's no information on the effects of this cream on the unborn baby. Thus, pregnant women should not apply this cream, unless it is recommended by the doctor.
Uses and Properties of Nystatin and Triamcinolone Acetonide
Mostly prescribed for the treatment of fungal/yeast skin infections, the topical application of this cream will not prove to be effective for a skin infection in which the causal organism is a bacterium, virus, protozoa, or trichomonad. This cream is available in 15 g, 30 g, and 60 g tubes. One gram of this cream provides 100,000 USP nystatin units and 1 mg triamcinolone acetonide. 'USP' is a registered trademark of the United States Pharmacopeial Convention, Inc. It is a unit used for measuring the potency of drugs.
Discovered by Rachel Fuller Brown and Elizabeth Lee Hazen in 1950, nystatin is derived from a bacterium called Streptomyces noursei. It is placed in the category of polyene antimycotics, which are defined as antimicrobial polyene compounds that target fungi. It works by augmenting the permeability of the cell membrane of sensitive fungi by binding to sterols. It binds to ergosterol in the fungal cell membrane, thereby weakening it. This is followed by the leakage of the K+ and Na+ ions. The leakage of intracellular potassium and sodium is the contributing factor for fungal cell death.
This drug is mainly used for inhibiting the growth of Candida. It can inhibit the growth of the following Candida species:
✦ Candida (Monilia) albicans
✦ Candida parapsilosis
✦ Candida tropicalis
✦ Candida guilliermondii
✦ Candida pseudotropicalis
✦ Candida krusei
✦ Candida glabrata
✦ Trichophyton rubrum (fungus that causes athlete's foot)
Triamcinolone acetonide is a synthetic corticosteroid, which is believed to be eight times more potent than prednisone. Synthetic corticosteroids are man-made drugs that are similar to cortisone, a naturally-occurring steroid that is produced by the adrenal cortex. These have anti-inflammatory, antipruritic, and vasoconstrictive properties. Thus, these help reduce inflammation and itching. These can also constrict the blood vessels, thereby reducing the redness observed in skin infections. Though nystatin cannot be absorbed by intact skin or mucous membranes, triamcinolone acetonide can be absorbed through skin that is intact. It is often used for treating skin conditions that are characterized by the following symptoms:
Storage and Directions for Application
The user must ensure that the cream doesn't come in contact with the eyes. The cream is just for dermatologic use. It should be protected from heat, direct light, or moisture. Store it in a closed container at room temperature, and ensure that it is not within the reach of children. This topical cream should be used under medical supervision for a duration that has been recommended by the physician. In general, this topical cream can be applied twice a day. It would be best not to apply it for more than a couple of weeks. As far as the application is concerned, you can either follow the directions provided on the label, or the instructions given below:
✦ First of all, wash your hands with an antibacterial soap and dry them properly.
✦ Wash the area affected by the fungal skin infection properly, and let it dry completely.
✦ Apply a small amount of cream on that area gently.
✦ Massage the cream on to the skin. If you are applying the cream on your face, make sure that the cream doesn't enter your eyes.
✦ In case of a missed dose, apply it at the earliest. However, if it is almost the time for the next dose, don't double the dose.
Side Effects and Drug Interactions
In case of nystatin, toxicity is associated with intravenous administration, but prolonged topical use must also be avoided. While nystatin cream is considered to be safe with minimal side effects, corticosteroids can cause adverse effects. In fact, applying a potent corticosteroid on a large surface area for extended periods can cause certain health problems. Using an airtight or watertight dressing over the applied area is believed to increase systemic absorption, which in turn might cause certain side effects. Thus, it is essential to follow certain precautionary measures to avoid such adverse effects. The topical application of nystatin and triamcinolone acetonide cream should be avoided if:
✦ You are allergic to any of the active or inactive ingredients of the drug.
✦ You are affected by a skin condition other than the condition for which this medicated cream was prescribed.
✦ You are experiencing adverse effects.
✦ You are pregnant or breastfeeding.
The topical application of corticosteroids should be limited in case of infants and young children, as they are more susceptible to systemic toxicity due to increased rate of absorption. If the cream has to be applied on the diaper area, ensure that the infant is not wearing tight-fitting diapers. This cream should be used for infants only if it has been prescribed by a doctor. The parents must strictly adhere to the guidelines regarding the dosage and the duration for which the drug has to be used.
This drug comes under Pregnancy Category C, as teratogenic studies have not been conducted for this combination drug. It is not known if this drug or any of its components are secreted in breast milk. Therefore, it would be best not to take this drug during pregnancy or breastfeeding, unless it is recommended by a doctor.
Triamcinolone acetonide could raise blood and urine sugar levels in individuals affected by severe diabetes. Thus, it is essential to inform the doctor about preexisting medical conditions. You must also inform your doctor about any prescription or non-prescription drugs that you have been taking.
Seek medical assistance on experiencing the following symptoms:
✦ Skin irritation
✦ Burning sensation
✦ Stinging sensation
✦ Acne-like eruptions
✦ Dry skin
✦ Skin discoloration (when applied on delicate skin on the face, armpits, or groin)
✦ Allergic contact dermatitis
There are certain symptoms that are indicative of absorption of triamcinolone through the skin. Do inform your doctor if you experience the following symptoms:
✦ Blurred vision
✦ Halos around lights
✦ Facial puffiness
✦ Weight gain
✦ Mood changes
✦ Irregular heartbeat
Medical assistance must be immediately sought, if one develops an allergic reaction after the topical application of this cream. The symptoms associated with a severe allergic reaction include:
✦ Dizziness/loss of consciousness
✦ Swelling of the face, tongue, or throat
✦ Breathing difficulty
Though nystatin is well-tolerated by people of all age groups, the same cannot be said for corticosteroids. In rare cases, increased absorption of the corticosteroids by the skin could cause irreversible hypothalamic-pituitary-adrenal (HPA) axis suppression. This is most likely to occur in case of prolonged use and application over large areas of the skin. HPA axis suppression can be diagnosed with the help of urinary free cortisol test and ACTH stimulation test. If the tests confirm HPA axis suppression, the cream should be discontinued or replaced with a less potent drug. Decreasing the frequency of application and dosage gradually will also prove beneficial.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.