Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin is a prescription cream that you put on the skin. It has four ingredients. Chlorhexidine gluconate is an antiseptic that kills germs on the skin. Clobetasol propionate is a very strong steroid that calms swelling, redness and itching. Miconazole nitrate is an antifungal that stops fungi from growing. Neomycin sulfate is an antibiotic that works against some of the bacteria that often infect damaged skin. Doctors may prescribe Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin for inflamed skin problems, such as eczema or psoriasis, when your doctor confirms the skin is also infected with bacteria or fungi. Clobetasol is much stronger than most skin steroids, so Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin is meant for short courses only.

Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin treats two problems at once: inflamed skin and the germs infecting it. Eczema and psoriasis can leave skin red, itchy, scaly and sore. Clobetasol is a corticosteroid that reduces this swelling, redness and itching. It is one of the strongest skin steroids available. On its own, clobetasol is used for eczema, psoriasis, lichen planus (an itchy rash of flat, purplish bumps) and discoid lupus (a long-term condition that causes scaly, scarring patches, often on the face and scalp). Clobetasol is also made in combination with an antibiotic and an antifungal for skin problems where infection is involved.

Inflamed, scratched skin can easily become infected with bacteria or fungi, and the other three ingredients deal with these germs. Neomycin is an antibiotic for skin infections caused by bacteria. It does not work against fungal or viral infections. Miconazole is an antifungal from the imidazole group that stops fungi from growing. Chlorhexidine is an antiseptic that helps clear germs from the skin surface. Your doctor may prescribe Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin for:

• Inflamed skin conditions that respond to steroids, such as eczema or dermatitis (red, itchy, inflamed skin), when the skin also has a bacterial infection
• Similar inflamed rashes that also have a yeast or fungal infection, as diagnosed by a doctor

Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin is not meant to be used on its own for ringworm (tinea), acne, rosacea, viral infections such as cold sores, or skin that is not infected. Do not use it by yourself for ringworm or other fungal rashes. Even though the cream contains an antifungal, the strong steroid can hide the infection and make it spread or keep coming back. In India, this kind of "steroid-modified" ringworm has become a common problem.

Clobetasol is very strong. If you use it for too long, on large areas, or under a covering, the steroid can be absorbed into the body. This can cause Cushing's syndrome (too much steroid in the body, causing weight gain and a rounded face) or adrenal insufficiency (the body not making enough of its own stress hormones). Neomycin can also pass into the body through broken skin and may affect the kidneys and hearing.

Do not use Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin for more than 2 weeks in a row, or use more than 50 g in a week, unless your doctor specifically tells you to. Do not use it on the face, groin or armpits unless your doctor has advised it. If your skin has not improved within 2 weeks, or it gets worse at any time, see your doctor.

1. Strong relief from inflammation - Clobetasol is one of the strongest skin steroids. It eases itching, redness, scaling and swelling in conditions such as eczema and psoriasis.
2. Helps treat certain bacterial infections - Neomycin works against some of the bacteria that often infect damaged skin.
3. Treats fungal infection - Miconazole stops the growth of fungi, including yeasts, that can infect damaged skin.
4. Cleans the skin surface - Chlorhexidine is an antiseptic that reduces germs on the skin.
5. Single application - Treats inflammation and a confirmed infection with one product. Use it only when your doctor has found both.

Common Side Effects (Usually Mild)

• Burning, stinging, pain, irritation or itching where the cream is applied
• Redness or dryness of the skin
• Cracking of the skin
• Acne, or tiny red bumps around the mouth
• Small white or red bumps on the skin
• Changes in skin colour

Serious Side Effects (Seek Urgent Medical Attention)

• Anaphylaxis (serious allergic reaction) - This is rare. It is a sudden, life-threatening allergy that can happen with clobetasol or chlorhexidine. Signs include a swollen face, lips, tongue or throat, difficulty breathing or swallowing, wheezing, a raised itchy rash, and feeling faint or confused. Call emergency services straight away.
• Allergic skin reaction to neomycin (allergic contact dermatitis) - The treated rash gets redder, itchier, more swollen or weepy instead of better. Neomycin is a common cause of skin allergy. Stop using the cream and see your doctor. If this happens, tell every future doctor that you are allergic to neomycin. You may also react to similar antibiotics such as framycetin or gentamicin.
• Skin thinning, visible blood vessels and stretch marks (striae) - Thin, shiny or easily bruised skin, small red lines on the skin, or stretch marks. These get worse with continued use and may be permanent. Stop and see your doctor promptly.
• Cushing's syndrome - Too much steroid builds up in the body. Signs include weight gain, a puffy or rounded face, changes in where body fat is stored, muscle weakness and changes in hair growth.
• Adrenal insufficiency - Steroid absorbed into the body can stop it from making enough of its own stress hormones. Signs include vomiting, muscle weakness, loss of appetite, weight loss, mood changes, unusual tiredness, dizziness or fainting.
• High blood sugar - Increased thirst and passing more urine. People with diabetes may see higher sugar readings.
• Eye problems - Blurred vision or other changes in sight. Clobetasol can raise the risk of cataract (clouding of the lens) and glaucoma (raised pressure in the eye).
• Ringing in the ears, hearing loss, dizziness or poor balance, or passing less urine - Neomycin can pass into the body through broken skin and may harm the hearing and kidneys.
• New or worsening skin infection - Redness, swelling or pus where the cream was applied, or skin sores.
• Severe or widespread skin rash - Stop using the product and contact a doctor.
• Pus-filled bumps (pustules) under the skin.
• Flare-up after stopping (topical steroid withdrawal) - After a strong steroid is stopped, the skin may become red, burning or stinging, very itchy, peeling or oozing. On brown or black skin, the redness may be harder to see.
• Depression or irritability

The longer you use the cream, and the larger the area you use it on, the higher the risk of serious side effects.

Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin is only for use on the skin. Never swallow it. Follow these steps unless your doctor has told you otherwise:

1. Wash your hands. Gently clean the affected skin and let it dry.
2. Squeeze out a small amount and spread a thin layer over the affected area only. A fingertip unit (a line of cream from your fingertip to the first crease) covers an area about twice the size of an adult's palm.
3. Rub it in gently until it disappears.
4. Wash your hands afterwards, unless you are treating your hands.
5. Do not cover the area with a bandage, dressing or plaster unless your doctor tells you to. Covering the skin increases how much medicine gets into the body.
6. Wait at least 30 minutes before putting any other product, such as a moisturiser, on the same skin.
7. Keep it away from your eyes, ears and mouth. Do not put it inside the ear, especially if you have, or might have, a hole in your eardrum. If it gets into your eyes, rinse them well with water. Do not use it on the face, in skin folds, in the armpits or groin, or in the genital or rectal area unless your doctor has said to.
8. Apply it at about the same times each day, as prescribed. Food and meals do not affect this medicine because it goes on the skin.
9. Use it only for as long as your doctor has advised. Ask your doctor before you stop, because skin can sometimes flare up after a strong steroid is stopped.

Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin is not recommended for children under 12 years and should not be used in the nappy area. Tight nappies and plastic pants act like an airtight covering. They greatly increase how much of the strong steroid (and neomycin) is absorbed into the body. Use it in a child only if a specialist specifically prescribes it.

Each of the four ingredients in Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin does a different job:

• Clobetasol propionate (very strong corticosteroid) - Corticosteroids are man-made versions of hormones the body uses to control swelling. Clobetasol is thought to work by making skin cells produce proteins called lipocortins. These proteins block an enzyme called phospholipase A2. This enzyme normally releases a building block that the body turns into prostaglandins and leukotrienes, the chemical messengers that cause swelling, redness and itching. Clobetasol also narrows small blood vessels in the skin.
• Neomycin sulfate (aminoglycoside antibiotic) - Neomycin attaches to the 30S part of the bacterial ribosome, which is the part of the cell that makes proteins. The bacteria then make faulty proteins and die. Neomycin does not work against every kind of bacteria, and it has no effect on fungi or viruses.
• Miconazole nitrate (imidazole antifungal) - Miconazole stops fungi from making ergosterol, a key building block of the fungal cell's outer layer (membrane). Without it, the membrane becomes leaky and the fungus stops growing.
• Chlorhexidine gluconate (antiseptic) - Chlorhexidine molecules carry a positive charge. They stick to the outer layer of germs and break it open, so the contents of the germ leak out.

Together, the steroid calms the inflammation while the other three ingredients deal with bacteria and fungi. A steroid used alone could let an infection get worse.

• Use only a thin layer, and only on the area your doctor told you to treat.
• Do not use it for more than 2 weeks in a row or more than 50 g a week unless your doctor says so.
• Do not use it on your own for ringworm or any fungal rash.
• Do not cover the treated skin with a bandage or plaster unless your doctor tells you to.
• Wait 30 minutes before putting a moisturiser or other cream on the same skin.
• Keep it out of your eyes, ears and mouth.
• Do not share it, and do not use leftover cream on other rashes later.
• Keep away from flames if fabrics have soaked up the cream, especially if it contains paraffin.
• Tell your doctor if you notice ringing in the ears, hearing changes, blurred vision, or you pass less urine than usual.
• Tell your doctor if your skin has not improved within 2 weeks.

• Store at the temperature printed on the pack. Clobetasol skin preparations are generally kept between 15°C and 30°C (59°F to 86°F).
• Keep it in its original container, tightly closed.
• Keep it away from heat and moisture, so not in the bathroom.
• Do not freeze or refrigerate it.
• Keep it out of sight and reach of children and pets.
• Do not flush unused medicine down the toilet. Ask your pharmacist about safe disposal.

Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin goes on the skin, so food and drink are not expected to affect it. You can eat and drink as normal while using clobetasol skin treatments.

Before you start Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin, tell your doctor about every medicine, vitamin, supplement and herbal product you use. Points to keep in mind:

• Blood thinners such as warfarin or acenocoumarol - Miconazole used on the skin or in the mouth can be absorbed and make warfarin stronger, which raises the risk of bleeding. Your doctor may check your INR (a blood clotting test) more often.
• Medicines that can harm the kidneys or hearing - Examples include gentamicin or amikacin, furosemide, vancomycin, amphotericin B, cisplatin and ciclosporin. Using these together with neomycin adds to the risk.
• Other steroid medicines (creams, tablets, inhalers or injections) - More than one steroid adds to the total amount in your body. This raises the risk of Cushing's syndrome and adrenal insufficiency.
• Other skin creams, ointments and moisturisers - Do not put other skin products on the treated area without asking your doctor. If you do use another product, wait at least 30 minutes after applying Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin.
• Surgery or dental treatment - Before any surgery, including dental surgery, tell the doctor or dentist that you are using clobetasol.

Always check with your doctor or pharmacist before starting any new medicine.

• Ringworm (tinea) or other fungal rashes - Do not treat these yourself. The steroid can hide the infection and help it spread.
• Viral skin infections - Do not use it on cold sores (herpes), chickenpox or shingles. Neomycin and miconazole do not treat viruses, and the steroid can make these infections worse.
• Acne, rosacea or a red bumpy rash around the mouth (perioral dermatitis) - Do not use it, because steroids can make these conditions worse.
• Perforated eardrum - Do not use it in or near the ear. Chlorhexidine and neomycin can damage hearing if they reach the middle ear.
• Glaucoma or cataract - Avoid use near the eyes and tell your doctor about these conditions.
• Broken skin, cuts or wounds - Do not use clobetasol on cuts or wounds. Neomycin is absorbed more easily through broken skin.
• Thin skin at the treatment site, or itchy skin that is not inflamed - Clobetasol may not be suitable.
• Kidney disease - Neomycin can cause kidney problems if it is absorbed into the body.
• Hearing problems - Neomycin absorbed into the body can cause hearing difficulty.
• Diabetes, Cushing's syndrome or liver disease - Tell your doctor before using clobetasol. Absorbed steroid can raise blood sugar.
• Allergy - Do not use it if you have ever had an allergic reaction to clobetasol, another steroid, neomycin, miconazole or chlorhexidine, or to similar antibiotics such as framycetin or gentamicin.

• Adults and children 12 years and over: apply a thin layer of Chlorhexidine Gluconate + Clobetasol + Miconazole + Neomycin to the affected area once or twice a day, as prescribed.
• Do not use more than 50 g in one week.
• Do not use it for more than 2 weeks in a row unless your doctor specifically advises it. Your doctor will check whether you still need the antibiotic and antifungal.
• Stop when your doctor says the skin is under control.
• Not recommended for children under 12 years.
• Check the strength of each ingredient on your pack. Always follow the dose and length of treatment your doctor gives you.

• If swallowed - Get medical help straight away and take the pack with you. If the person has collapsed or is not breathing, call emergency services.
• Using too much or for too long on the skin - Enough steroid can be absorbed to affect the whole body. This can lead to Cushing's syndrome (weight gain, puffy face, muscle weakness), adrenal insufficiency (vomiting, weakness, dizziness, extreme tiredness) or high blood sugar.
• Too much neomycin through broken skin - This can cause ringing in the ears, hearing loss, and passing less urine because of kidney problems.

Contact your doctor if you think you have used too much. Do not stop suddenly without advice.

Apply the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed one and carry on with your usual schedule. Do not apply a double amount to make up for a missed dose.

Call emergency services straight away if you have:

• Swelling of the lips, mouth, throat or tongue
• Difficulty breathing, wheezing or a tight throat
• Skin, lips or tongue turning blue, grey or pale
• Sudden confusion, drowsiness or fainting

Contact your doctor promptly if you notice:

• Ringing in the ears, hearing loss, dizziness or poor balance, or passing less urine than usual
• Blurred vision or any change in eyesight
• The treated rash becoming redder, itchier, swollen or weepy (possible allergy to neomycin)
• Redness, swelling or pus where the cream was applied
• A severe or widespread rash, or skin sores
• Thin, shiny skin, stretch marks or small red lines on the treated skin
• Sudden weight gain, a rounder face, or changes in where body fat is stored
• Increased thirst or passing more urine, or higher sugar readings if you have diabetes
• Unusual tiredness, muscle weakness, vomiting or loss of appetite
• Depression or irritability
• Skin that gets worse at any time, or has not improved within 2 weeks
• A flare of redness, burning or peeling after stopping the cream