Clotrimazole cream - The Punch

This cream is truly an antifungal preparation, a medication dedicated to the defeat of certain fungal infections that afflict the skin and its folds. In the ordinary terms of usage, this cream is abused to the extent that women, in particular, use it as an addition to their skin preparations and also as a vaginal lubricant. They add it regularly to their numerous beauty products especially since it is labelled as a cream and has been prescribed without let by all and sundry. However, this medication is available in different formats and is therefore available as a tablet, a cream which we all know and as a vaginal pessary. It was discovered in 1969 and is today one of the most commonly obtained over-the-counter medications in many countries. It was originally introduced as Canesten and that remains one of the best-known brand names but there are many generic formulations now available in pharmacies and chemists. In addition, it is available on the World Health Organisation's list of essential medicines. Consequently, it is available as a topical cream, ointment or vaginal suppository.

This medicine is used in the treatment of diaper rash, various types of ringworm, oral thrush, vaginal yeast infections, jock itch and athlete's foot. It is also used in the treatment of a specific fungal infection called pityriasis versicolor which many people wrongly call eczema. For these people, therefore, clotrimazole cream is deployed in the treatment of eczema as well and this is simply not effective treatment for that. The oral preparation of this medicine and taken by mouth often elicits common side effects like itching and nausea. The oral route is not recommended for use by those who have liver disease. However, it is safe for the people with liver disease to use if they are applying it to their skin only. When applied to the skin, where most people are comfortable with its use, it can cause a burning sensation and associated redness of the skin. As a pessary, which is a large tablet really, it can be inserted in the vagina by hand or with an applicator. It is not known to provoke any adverse reaction with the concurrent use of any other medication on the skin.

This medication is available as a throat lozenge, a lot like strepsils, only that in its form it is used for the specific incidence of thrush in the mouth and the back of the mouth, known as the oropharynx. It can also be used in preventing these forms of fungal infections in people who have a compromised immune status. Usually, it is applied to the skin or vagina two times a day for the duration of treatment while in the treatment of oral thrush it is used as much as five times a day. In some instances, clotrimazole is added together with steroids such as betamethasone and used in the treatment of jock itch, athlete's foot and ringworm but such usage must be finite and regulated properly to avoid a situation of loss of skin thickness from the prolonged effect of the steroid in it. As a rule, this makes it far more harmful for long-term usage when the combination is used routinely as a cream like many of our women do. For the best results to be obtained from the use of this drug, it is better to avoid these combinations. Clotrimazole is not effective for the treatment of fungal infections of the nails and scalp.

The use of clotrimazole has no age limit; it can be used in both adults and children as well as in pregnant women in both the topical format or as lozenges. In this oral formulation, a small percentage of patients will experience nausea, vomiting and body itching. Another group using the cream to treat vaginal infections will experience some burning sensation in a small minority of patients. However, people must know that burning or itching of the penis of the woman's sexual partner is possible too and that abnormal swelling of the penis and the vulva can also occur. When it is applied to the skin, clotrimazole can also cause blisters, rashes, burning, itching, peeling, redness, pain and every other kind of skin irritation when in use by people who are susceptible to these side-effects. Finally, this preparation also contains oil which can degrade the integrity of condoms and vaginal diaphragms such that they might not be reliable barrier methods for contraception during the time of usage. In the most important connection, however, it is useful to emphasize that this cream has little or no adverse interaction with any other medication that is used with it.

From all that has been written above, it is clear that this cream was never intended as a part of the daily cream application which a lot of people now subject it to. What may convince many others to apply it is that very few users actually suffer from any significant side-effects it might cause. It is an Azole antifungal compound that works by preventing the growth of fungus, including candida that is responsible for the majority of vaginal fungal infections. It does this by disrupting the integrity of the cell membrane of the offending fungus. There are less popular offerings of clotrimazole and these are as a powder and as a spray. While these formulations cannot be used in the mouth, for example, they are available for use as skin treatments and vaginal applications. The use of the powder is particularly easy on people who are treating athlete's foot because it keeps the feet dry and the webs of the toes as well. Somehow, it is some matter for concern that this cream has found widespread use for vaginal lubrication and a beauty cream. Particularly in the former role, it can be seen that the sexual partner of the female user often bears some of the brunt for using it.

In the final analysis, just like it is with other medications, an adherence to the instructions for its use will help achieve much. Application to an area two times a day is the norm. Many people do not suffer from adverse effects. The cream is safe to a large extent just like the powder and the spray as well. However, for the road, it is important to disclose that this cream has found some interest in the treatment of sickle cell disease, malaria and certain kinds of cancer. The minimal side effects it causes and its uncomplicated metabolic profile have been its strongest points in helping to treat the outbreaks of vaginal yeast infections and athlete's foot in college dormitories and prisons. While most of its effects are produced by the action it has on the interruption of the ergosterol biosynthesis, it also depletes the calcium levels within the cells and blocks the potassium channels within cells. Some of these activities are responsible for the attraction it holds today for treating the other conditions mentioned above. Ergosterol is an essential component of the cell wall of fungi and when this compound is prevented from its formation, the fungi fail to grow. That stops the advance of whatever disease it is causing.

Questions and answers

Dear doctor, I have been feeling dizzy for some time now and I went to a hospital for the doctor to check me and recommend tests. After the tests were done, I failed to see any improvement in my condition and in addition, I am feeling so heavy. What should I do now, sir? I trust you to provide me with a solution. I did blood count, blood sugar, malaria and others. The sugar was found to be high in the original test but when the fasting and random were done the following day, they were normal. I was not given any medicines but I don't feel better. I need a solution please. One of my neighbours slumped at his dining table four nights ago and died there. That is the third such case I am getting to hear about of late. It is worrisome. Thank you. 0802xxxxxxx 

This is a good step you took by going to a hospital to complain. However, many important facts are lacking such as your gender, age and weight. It is good to know that you are not on treatment for any condition. If you were, we could have blamed it on what medications you are taking. In the absence of all that, what one can say is that no treatment has been offered to you apparently because nothing noteworthy was found. In that case, my advice would be to observe things for a couple of weeks and either pay a repeat visit to that hospital or go elsewhere to obtain a second opinion.

Dear doctor, may God bless you for doing this wonderful job we read every Sunday on health. Thanks and I would like to know; when you see foam in your urine, what does it mean and what is the way out?   I missed it. Thanks.   07032xxxxxxx

Thank you very much for the comments you have made. Foam appearing in the urine is not a significant observation most of the time. However, that is only a valid point if it is something that occurs occasionally. If it becomes persistent, you will have to see a doctor and get an assessment of your renal system done to determine if something is wrong. Usually, foam in the urine can be found in association with the following conditions:

. The kind of food you eat. If you eat a food rich in protein, you are likely to observe some foam in your urine.

.If the speed with which you pass out your urine is high, some foam will appear in the urine.

.If the cleansing lotion you use to keep your water closet clean contains soap like virtually all of them do, there will be foam in your urine.

. The same thing will happen when someone is dehydrated.  However, all these conditions are reversible and are dependent on the conditions around you. If it becomes a persistent observation, there may be some kidney-related condition.

Deer doctor, thanks for your wonderful articles. Please I am a 22-year-old female and I have this recurrent eczema on my face. I have been to the doctor and I was asked to use Hydrocortisone cream but when I stop the application, my face flares up again. I have also used Skineel. Is it possible for it to go completely? 0701xxxxxxx

Thank you very much for your kind words. It is possible for this condition which you call eczema to go completely but that is dependent on whether what you have called it is accurate. Most times, several skin conditions look alike but are different in the eyes of a doctor who is trained to deal with such problems. Eczema is an ugly skin disease that may produce water and what you are talking about so lightly does not appear to be so. I would urge you to read this week's essay carefully and then go to another doctor for some further examination.

Dear doctor, my complaint is about malaria fever. Though it appears as simple as it is, it is a dangerous ailment. I am 72 years old and my genotype is AA while my blood group is B positive. I don't need to state all the known malaria medicines I have consumed. I have had to treat malaria with a drug called every Sunday medicine. Are they not available again? Or is there any new invention? Your solution to our medical problems is as good as attending a hospital itself. Every six weeks, I use insecticide-treated mosquito nets as well although my surroundings are bushy where I reside. When we were growing up, there was prevention. May the Almighty God enrich your knowledge, sir. Amen.  0803xxxxxxx       

Thank you very much for your very kind words and your prayers. God will bless you sir. Amen. The medicine I suppose you are referring to is Sunday-Sunday medicine which was an advertorial song. That drug is known as Daraprim or more properly, Pyrimethamine. It is a medication used in the prevention of malaria and is recommended for use once a week. Now, Sunday being a traditional day of rest was deemed a good day for most people to remember to use it hence the name, Sunday-Sunday medicine. To answer your question, it is still available and it remains in use for malaria prevention or prophylaxis. However, there are frequent incidents of breakthrough malaria with its use and although it is still well prescribed in many antenatal clinics, the drug is clearly not as effective as it used to be. The new medicine in that role of malaria prevention is the malaria vaccine that looks set to become available to many people within two to three years. Malaria remains a dangerous infection for anybody to have and it still kills more people in Africa than tuberculosis, road accidents and HIV/AIDS put together every year. For an individual like you who has the AA genotype, you have less natural immunity against malaria than someone who is AS or AC genotype. Finally, the best place to get proper treatment is the hospital but what we try to do here is to provide readers like your good self with informed choices and advice about what to do.

Dear doctor, stroke is a terrible ailment. It affected my late dad, made him a cripple and killed him within 10 months. Thank you. 0806xxxxxxx

Thank you for this comment and sorry about your father. Stroke is not an ailment per se. It is rather a complication of a set of conditions which we discussed in the essay on stroke. That essay was the second one dedicated to stroke. The first one in 2016 was about how stroke develops. This last one was about the consequences of the condition and what measures are available to manage it. Either way, it is always bad news and it is better to prevent it from happening.

 Dear doctor, please I have a terrible problem with passing stool. I used to go to the toilet on a daily basis but over the last one week I have not been able to go. Not long ago, I tried to force myself and saw some blood. The stool itself was like a stone. What should I do? Can I use Dulcolax? Thank you.  0803xxxxxxx

Good day to you as well. Certainly, you can use Dulcolax. It helps a great deal and depending on your age, you can get the tablets or use the rectal suppositories.

 

Dear doctor, I am the 78-year-old fellow who wrote to you a few weeks ago asking for advice on his hoarse voice. While you thought this condition could be due to old age, you did advise me to see an ENT specialist. I was examined by one ENT specialist who advised that I should go for screening and the report is what I will forward to you below;

"Fibre-optic laryngoscopy was done on account of hoarseness and the base of tongue, valleculae, epiglottis, aryepiglottic folds, false cords, arytenoids and piriform fossa are essentially normal. The vocal cords are a bit oedematous and inflamed but fully mobile. I would advise voice rest for the patient"

 Where do I go from here? I must thank you once again for the painstaking and highly professional manner you are handling your readers' request. 0802xxxxxxx

Good morning to you sir. Thank you so very much for your kind words. It is impressive that you took our advice and had a proper examination conducted. That way, there will be no guesswork involved and we are all the wiser. You have done a good and positive thing and the cause of this condition may be talking a lot or singing. Politicians and singers and other stage performers suffer from this kind of thing a lot and it may actually be worse in those people because they develop small swellings on the cords as well. So the advice would be in agreement with the above, namely:

. Voice rest by talking less and communicating more by writing or texting

.Drink warm-hot beverages to promote better drainage from the cords

.Take lozenges like Strepsils which should provide some soothing feeling

.Allow a decent interval to pass between eating a meal and lying down because the reflux of stomach acid can cause this kind of reaction.

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