Viaderm KC Cream and Ointment
Gramicidin; neomycin as sulphate;triamcinolone acetonide; nystatin

Presentation
Cream: 0.025% gramicidin, 0.25% neomycin, 100 000U nystatin, 0.1% triamcinolone acetonide, per gram.
Ointment: 0.025% gramicidin, 0.25% neomycin, 100 000U nystatin, 0.1% triamcinolone acetonide, per gram.

Uses
Actions
Triamcinolone acetonide is a potent fluorinated corticosteroid with rapid anti-inflammatory action, anti-pruritic and anti-allergic actions.
The combined action of the antibiotics neomycin and gramicidin provides comprehensive antibacterial therapy against a wide range of Gram-positive and Gram-negative bacteria, including those micro-organisms responsible for most bacterial skin infections.
Nystatin is an antifungal antibiotic, active against a wide range of yeasts and yeast-like fungi, including Candida albicans.
Indications
The topical treatment of superficial bacterial infections, cutaneous candidosis and dermatological conditions known to respond to topical steroid therapy when threatened or complicated by bacterial or candidal superinfections. These include; atopic eczema, contact eczema, follicular eczema, infantile eczema, anogenital pruritis (anal and vulval pruritis), nummular eczema, post-traumatic infective eczema, seborrhocic or flexural eczema, neurodermatitis, psoriasis.

Dosage and Administration
Adults and Children:
Apply to the affected areas two to four times daily.
Elderly: Natural thinning of the skin occurs in the elderly; hence corticosteroids should be used sparingly and for short periods of time.

Contraindications
In tuberculosis and most viral lesions of the skin, particularly herpes simplex, vaccinia and varicella. Also in fungal lesions not susceptible to nystatin. In patients with hypersensitivity to any of the components.
Should not be applied to the external auditory canal in patients with perforated eardrums.

Warning and Precautions
Adrenal suppression can occur, even without occlusion. The use of occlusive dressings should be avoided because of the increased risk of sensitivity reactions and increased percutaneous absorption. The possibility of sensitivity to neomycin should be taken into consideration especially in the treatment of patients suffering from leg ulcers.
Pregnancy: Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. The relevance of this finding to humans has not been established. However, topical steroids should not be used extensively in pregnancy i.e. in large amounts for long periods. Topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus.
Children: In infants, long term continuous topical steroid therapy should be avoided.

Adverse Effects
Triamcinolone acetonide is well tolerated. Where adverse reactions occur they are usually reversible on cessation of therapy. However, the following side effects have been reported usually with prolonged usage.
Dermatological:Impaired wound healing, thinning of the skin, petechiae and ecchymoses, facial erythema and telangiectasia, increased sweating, purpura, striae,
Hirstism, acneform eruptions, lumps erythematosus-like lesions and suppressed reactions to skin tests. These effects may be enhanced with occlusive dressings. Signs of systemic toxicity such as oedema and electrolyte imbalance have not been observed even when high topical dosage has been used. The possibility of the systemic effects which are associated with all steroid therapy should be considered.
Neomycin: Sensitivity reactions may occur especially with prolonged use. Ototoxicity and nephrotoxicity have been reported. Large amounts of this product should be avoided in the treatment of skin infections following excessive burns, trophic ulceration and other conditions where absorption of neomycin is possible.
Gramicidin: Sensitivity has occasionally been reported.
Nystatin: There have been no substantiated reports of sensitivity associated with topical nystatin.

OVERDOSAGE
Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects.
Pharmaceutical Precautions
Cream and Ointment: Store below 25°C
Dilution: Not recommended, as this would reduce concentration of the antibiotics to below therapeutic levels.

Medicine Classification
Prescription Medicine

Package Quantities
Cream and ointment: 15g tubes.

 

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.