Ointment Triderm for psoriasis

Triderm is a pharmacological group of topical hormone-containing agents of a combined composition used in dermatology. ATX code is D07C C01. Manufacturer - Schering-Plow Labo NV (Belgium).

Other trade names are: Triacutan, Anekzem, Kandiderm, Canison Plus.

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Indications Triderma in psoriasis

According to the official instruction, Triderm is not prescribed for psoriasis, and indications for the use of this remedy are: various types of dermatoses - in case of their complication with a bacterial infection; pustular skin lesions (impetigo); microbial and mycotic eczema; dermatomycosis (including on the soles of the feet); superficial pseudomycosis (erythrasma), as well as lichen of fungal origin.

Does Triderm treat psoriasis? The composition of Triderma includes fungicidal (antifungal) Clotrimazole, the content of which in 1 g of the drug is 10 mg or 1%; antibiotic Gentamicin (1 mg or 0.1%) and fluorinated glucocorticosteroid (GCS) Betamethasone dipropionate, which accounts for only 0.05% (0.5 mg per 1 g).

Psoriasis is an autoimmune disease, not an infectious disease, and only Betamethasone is used externally in its components from the Triaderm component, and this GCS is not used in the basic form of psoriasis - extensive vulgar (plaque).

Therefore, Triderm in psoriasis, like all ointments with antibiotics or fungicides, dermatologists appoint only in cases of infection, which significantly complicates the disease and worsens the condition of patients. Most often this is due to secondary infection - the development of dermatomycosis or streptococcal pyoderma - with psoriatic rashes on the inner surfaces of the hips, in the inguinal folds or underarms.

Triderm for psoriasis of nails - psoriatic onychodystrophy, onycholysis or subungual hyperkeratosis - is not applied. For more details see -  Psoriasis of nails

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Release form

The triderm is available in the form of an ointment and cream (in tubes with a capacity of 15 or 30 g).

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Pharmacodynamics

The mechanism of pharmacological action of Triderm is provided by its active substances. Thus, the anti-inflammatory effect of Betamethasone (a strong GSK of the third class) is due to the blocking of the synthesis of proinflammatory mediators-cytokines of the group of interleukins and chemokines-immunocompetent cells (B and T lymphocytes), keratinocytes, dendritic cells and macrophages of the epidermis. And antipruritic action and decrease in swelling of inflamed tissues are the result of activation of lipocortin, which suppresses the production of COX, prostaglandins, leukotrienes and thromboxanes.

Antifungal drug from the group of imidazole derivatives, Clotrimazole, disrupts the biosynthesis of sterols from the membranes of dermatophyte cells, yeast-like and mold fungi (Microsporum, Trichophyton, Epidermophyton, Pityrosporum, Candida, Torulopsis, Cryptococcus, Asppergillus).

Aminoglycoside antibiotic Gentamicin, penetrating the cells of microbes, has a bactericidal and bacteriostatic effect on the pathogens of many infections by disrupting the processes of protein synthesis of bacteria, in particular, Staphylococcus spp. Pseudomonas aeruginosa, E. Coli, Shigella spp., Klebsiella spp. And some others. However, many strains of Streptococcus spp. This antibiotic does not work.

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Pharmacokinetics

Data on the pharmacokinetics of ointment and cream Triderm in the instructions are absent. But there is a warning about an increase in the likelihood of percutaneous absorption and systemic adsorption of the ingredients of the drug (Gentamycin and Betamethasone) when applied in areas with damaged epidermis or over a large area of the skin (<10% of the body surface area).

It is known that corticosteroids can be absorbed through intact skin, after which they, like systemic SCS, bind to one degree or another plasma proteins. Corticosteroids are metabolized mainly in the liver, and then excreted by the kidneys or through the intestine - with urine and bile.

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Dosing and administration

Ointment or cream Triderm should be applied very thinly to the affected areas of the skin - twice a day (in the morning and before bedtime). It is not recommended to apply bandages.

The maximum duration of this drug is three weeks.

The instruction states that the use of Triderm for children under the age of two is prohibited, although Gentamicin is used in pediatrics only for children over three years of age.

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Use Triderma in psoriasis during pregnancy

In experimental studies involving animals, the teratogenic effect of GCS for topical application has been established. Betamethasone is contraindicated in the first three months of pregnancy and during the entire lactation period. Also in question is its use at a later date.

Data on the external use of aminoglycosides in pregnancy, in particular Gentamicin, are inadequate, but systemic use of this antibiotic is prohibited due to its ototoxic effect.

Clotrimazole is not used in the treatment of pregnant women during the first trimester.

Contraindications

In addition to hypersensitivity to the components of ointments or Triderm cream, contraindications to their use relate to rashes with syphilis and any forms of skin tuberculosis; herpes and chicken pox; open wounds, ulcers and skin erosions.

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Side effects Triderma in psoriasis

Triderm in psoriasis and infected dermatitis can cause side effects, which are manifested by local irritation, flushing, burning and itching of the skin; dehydration of the epidermis with desquamation; inflammation of the hair follicles; the appearance of hypopigmented spots; the development of steroid acne.

Long-term use of Triderma can lead to systemic side effects of glucocorticosteroids in the form of puffiness; increased blood pressure, body weight and blood glucose levels; reduction in bone strength and gastrointestinal problems. The most likely such side effects, as well as the development of hypercortisy syndrome in children.

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Overdose

Signs of an overdose of Triderm are: development of superinfection, hypercorticoid syndrome, kidney failure and hearing loss.

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Interactions with other drugs

It is possible to enhance allergic reactions while using systemic antibiotics of the aminoglycoside group.

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Storage conditions

Cream and ointment Triderm should be stored at normal room temperature.

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Shelf life

The expiration date of the drug is indicated on the carton.

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Doctor's comments

As evidenced by the reviews of dermatologists, the popularity of glucocorticosteroid drugs in psoriasis is inferior only to agents that have keratolytic effects (due to the content of salicylic acid, urea, zinc, hydroxyvitamin D3, solidol or anthracene). More information in the material -  Ointments for psoriasis

In addition to Triderma, when complicating psoriasis with a bacterial infection, doctors recommend cheaper analogues - ointments with betamethasone and gentamicin: Belogen, Betaderm, Diprogen, Kuterid, Celestoderm-B. And with mycoses against the background of psoriasis - cream Candide B (Betamethasone + Clotrimazole). 

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