clobetasol propionate
Dermovate ◆, Olux, Temovate

Available forms
Available by prescription only
Cream: 0.05%
Foam: 0.05%
Gel: 0.05%
Ointment: 0.05%
Solution: 0.05%

Indications and dosages
 Inflammation of corticosteroid-responsive dermatoses. Adults: Apply a thin layer to affected skin areas b.i.d., once in the morning and once at night. Limit treatment to 14 days, with no more than 50 g of the cream or ointment or 50 ml of lotion (25 mg total) weekly.
 Inflammation and pruritus of moderate to severe corticosteroid-responsive dermatoses of the scalp. Adults: Apply to affected scalp area twice daily, once in the morning and once at night. Invert can and dispense small amount of Olux foam (to a maximum of a golf-ball-size dollop) into the cap of can, onto a saucer or other cool surface, or directly on the lesion, taking care to avoid contact with the eyes. Dispensing directly onto hands isn’t recommended because the foam will begin to melt immediately upon contact with warm skin. Move hair away from affected scalp area so that the foam can be applied to each affected area. Gently massage into affected area until the foam disappears. Repeat until entire affected scalp area is treated. Limit treatment to 14 days, with no more than 50 g of foam weekly.

Pharmacodynamics
Anti-inflammatory action: Drug is effective because of anti-inflammatory, antipruritic, and vasoconstrictive actions; however, the exact mechanism of its actions is unknown. Clobetasol is a high-potency group I fluorinated corticosteroid that’s usually reserved for the management of severe dermatoses that haven’t responded satisfactorily to a less potent formulation.

Pharmacokinetics
Absorption: Amount absorbed depends on the potency of the preparation, the amount applied, and the nature of the skin at the application site. It ranges from about 1% in areas with a thick stratum corneum (such as the palms, soles, elbows, and knees) to as high as 36% in areas with a thin stratum corneum (face, eyelids, and genitals). Absorption increases in areas of skin damage, inflammation, or occlusion. Some systemic absorption of topical corticosteroids occurs, especially through the oral mucosa.
Distribution: After topical application, clobetasol is distributed throughout the local skin. Any drug absorbed into the circulation is rapidly removed from the blood and distributed into muscle, liver, skin, intestines, and kidneys.
Metabolism: After topical administration, drug is metabolized primarily in the skin. The small amount absorbed into systemic circulation is metabolized primarily in the liver to inactive compounds.
Excretion: Inactive metabolites are excreted by the kidneys, primarily as glucuronides and sulfates, but also as unconjugated products. Small amounts of the metabolites also are excreted in feces.

Contraindications and precautions
Contraindicated in patients hypersensitive to corticosteroids.

Interactions
None reported.

Adverse reactions
GU: glucosuria.
Metabolic: hyperglycemia.
Skin: burning, pruritus, irritation, dryness, erythema, folliculitis, perioral dermatitis, allergic contact dermatitis, hypopigmentation, hypertrichosis, acneiform eruptions.
Other: hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome.

Effects on lab test results
• May increase blood glucose level.

Overdose and treatment
No information available.

Special considerations
• Applying occlusive dressings or bandages over treated area isn’t recommended.
• Apply sparingly in light film.
• Pulse therapy is sometimes used with topical corticosteroids of this potency; that is, twice daily for 3 days, then none for 3 days. Intermittent use prevents cumulative effects. Drug suppresses HPA axis at doses as low as 2 g daily.
• Discontinue drug if skin infection, striae, or atrophy occurs.
Pregnant patients
• Because of the possibility of teratogenic effects, avoid use in pregnancy.
Pediatric patients
• Drug treatment isn’t recommended in patients younger than age 12.

Patient education
• Inform patient of potential adverse reactions.
• Advise patient to avoid contact with eyes.
• Warn patient not to use drug for longer than 14 days.
• Advise patient that contents of Olux foam are under pressure and not to puncture or incinerate container. Warn patient not to expose container to heat or store at temperatures above 120° F (49° C).
• Contents are flammable. Avoid flame and smoking during and immediately following application.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use