“If this blog helped you out, don’t keep it to yourself—share the link on your socials!” 👍 “Like what you read? Spread the love and share this blog on your social media.” 👍 “Found this useful? Hit share and let your friends know too!” 👍 “If you enjoyed this post, please share the URL with your friends online.” 👍 “Sharing is caring—drop this link on your social media if it helped you.”

Sunday, July 27, 2025

Clobetasol


Clobetasol is a very potent topical corticosteroid, used to manage severe inflammatory skin conditions that have not responded to less potent steroids. It is particularly effective in controlling symptoms such as inflammation, redness, itching, and thickened plaques associated with chronic dermatologic disorders. Clobetasol is often considered the highest potency class of topical steroids and is restricted to short-term use due to its high risk of systemic absorption and side effects.

This professional reference covers its classification, mechanisms, therapeutic indications, dosing, adverse effects, contraindications, precautions, and drug interactions.

Pharmacological Classification

  • Drug Class: Topical corticosteroid

  • Potency: Very potent (Class I) — among the most potent steroids available for dermatologic use

  • Form: Cream, ointment, lotion, shampoo, foam, solution, gel, and spray

Brand Names

  • Dermovate® (UK and global markets)

  • Clobex® (shampoo, lotion – U.S.)

  • Temovate® (U.S.)

  • Olux® (foam – U.S.)

  • Cormax®

  • Generics labeled as Clobetasol propionate 0.05%

Mechanism of Action

Clobetasol binds to glucocorticoid receptors in the cytoplasm of skin cells, initiating a sequence of events:

  • Suppression of inflammatory gene expression

  • Reduction of cytokine production

  • Inhibition of inflammatory cell infiltration

  • Vasoconstriction of capillaries

These actions result in strong anti-inflammatory, antipruritic, and vasoconstrictive effects, relieving symptoms associated with severe skin diseases.

Therapeutic Indications

Clobetasol is indicated for short-term treatment of steroid-responsive dermatoses unresponsive to milder corticosteroids:

  • Psoriasis (excluding widespread plaque psoriasis and pustular psoriasis)

  • Lichen planus

  • Lichen simplex chronicus

  • Discoid lupus erythematosus

  • Eczema (severe forms)

  • Seborrhoeic dermatitis (scalp)

  • Atopic dermatitis (unresponsive)

  • Dermatitis herpetiformis (off-label)

  • Hypertrophic scars

  • Alopecia areata (topical application to stimulate hair regrowth)

  • Vitiligo (short-term localized use)

Dosage and Administration

  • Strength: Clobetasol propionate 0.05%

  • Frequency: Apply once or twice daily to the affected area

  • Maximum Duration: Use for no longer than 2 weeks continuously

  • Maximum Weekly Dose: Do not exceed 50 g/week

  • If long-term control is needed, intermittent use (e.g., weekends only) is advised

Application Guidelines

  • Apply a thin film to clean, dry skin

  • Do not apply to the face, groin, or axillae unless directed

  • Avoid occlusive dressings unless prescribed

  • Not suitable for children under 12 years unless under specialist supervision

Form-Specific Notes

  • Foam/Spray: Effective for scalp psoriasis and hairy areas

  • Shampoo: Leave on for 15 minutes, then rinse (e.g., Clobex Shampoo)

  • Scalp lotion: Apply sparingly; avoid dripping into eyes

Pharmacokinetics

  • Absorption: Varies depending on skin condition, area treated, and use of occlusion

  • Systemic absorption: Up to 3–15% may enter circulation

  • Metabolism: Hepatic

  • Elimination: Primarily in urine as inactive metabolites

Increased absorption risks arise with:

  • Application to damaged or thin skin

  • Use on large surface areas

  • Prolonged treatment

  • Use of occlusion

  • Use in children

Contraindications

  • Hypersensitivity to clobetasol or excipients

  • Viral skin infections (e.g., herpes simplex, varicella)

  • Fungal infections (e.g., candidiasis, dermatophytes) unless treated concurrently

  • Bacterial skin infections (e.g., impetigo)

  • Rosacea

  • Acne vulgaris

  • Perioral dermatitis

  • Ulcerated areas, perianal, or genital regions

  • Children under 12 years (unless specified)

Precautions and Warnings

  • Use only for short durations and avoid treating large areas

  • Avoid face, groin, and axillae unless under medical direction

  • Use with caution in children, pregnant, or lactating women

  • Risk of HPA axis suppression, especially with long-term or high-dose use

  • May cause iatrogenic Cushing’s syndrome

  • Avoid eye contact—can cause glaucoma and cataracts

  • Abrupt withdrawal may cause rebound flaring

  • Increased risk of skin thinning, striae, telangiectasia, and dermal atrophy

Adverse Effects

Local Effects

  • Burning, itching, irritation

  • Skin atrophy, striae, telangiectasia

  • Hypopigmentation

  • Perioral dermatitis

  • Acneiform eruptions

  • Contact dermatitis (allergic or irritant)

  • Hypertrichosis

  • Delayed wound healing

Systemic Effects (especially with excessive use)

  • Adrenal suppression

  • Cushingoid features (moon face, weight gain, hypertension)

  • Hyperglycemia

  • Glaucoma and cataract (if applied near eyes)

Children are particularly susceptible to systemic side effects

Drug Interactions

Clobetasol is topically administered and systemic absorption is typically limited; however, possible interactions include:

  • CYP3A4 inhibitors (e.g., ritonavir, itraconazole): May enhance corticosteroid systemic effects

  • Topical antimicrobials: Concurrent use often necessary in infected lesions

  • Vaccines: Avoid live vaccines in immunosuppressed patients using potent topical steroids

  • Other corticosteroids: Risk of additive systemic effects

Use in Pregnancy and Lactation

Pregnancy

  • Category C (U.S.): No adequate studies in humans

  • Avoid use on large areas, for long durations, or under occlusion

  • Use only if benefits outweigh risks

Lactation

  • Limited data on excretion in breast milk

  • Avoid applying to nipple or chest area if nursing

  • Short-term, limited use is generally considered low risk

Withdrawal and Rebound

  • Abrupt discontinuation after long-term use can cause rebound inflammation, worsening of dermatoses, or steroid withdrawal syndrome

  • Tapering or intermittent application recommended for chronic diseases like psoriasis

Patient Counseling Points

  • Apply a thin layer, not more than prescribed

  • Do not cover with dressings unless instructed

  • Avoid face and sensitive areas unless specifically directed

  • Use for short durations only

  • If symptoms do not improve within 2 weeks, reassess the diagnosis

  • Wash hands after application unless treating the hands

  • Report signs of skin thinning, bruising, or visual changes

  • Avoid concomitant irritants, cosmetics, or medicated skin products unless approved

  • Do not share medication — it is prescription-only for individual use

Monitoring Parameters

  • Clinical improvement in lesions

  • Signs of skin atrophy, hypopigmentation, or telangiectasia

  • If prolonged or high-dose use: monitor for HPA suppression (e.g., morning cortisol)

  • For scalp or facial use: monitor intraocular pressure if near the eyes

  • Blood glucose in long-term users with diabetes or signs of hyperglycemia

Alternatives

Depending on severity and site of inflammation:

  • Lower potency steroids: Hydrocortisone, clobetasone

  • Non-steroidal agents: Pimecrolimus (Elidel), tacrolimus (Protopic)

  • Combination therapies: Clobetasol + antifungal (e.g., clobetasol + miconazole)

  • Coal tar or salicylic acid for thick plaque psoriasis

  • Vitamin D analogs (e.g., calcipotriol) for long-term control




on
Labels:

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)