clobetasol propionate

Action and Spectrum

Actions and spectrum: 

clobetasol propionate is a high potency synthetic corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive properties.

It is used topically as a cream, ointment, foam, gel, or scalp solution for the treatment of various inflammatory and pruritic skin conditions such as eczema, psoriasis, dermatitis, and other allergic skin reactions.

The exact mechanism of action of clobetasol propionate is not well known, but it is believed to inhibit inflammatory cytokines and enzymes, decrease the number of immune cells in the skin, and reduce skin blood flow by vasoconstriction. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10% 

Lotion 

• Dry skin (1%) 
• Discomfort skin (1.3%) 
• Telangiectasia (3.2%) 
• Skin atrophy (4.2%)

Frequency not defined 

Skin atrophy 

Burning 

Erythema 

Irritation 

Pruritus 

Hypopigmentation 

Adrenal suppression 

Secondary infection 

HPA suppression 

Striae 

Fissuring/cracking of the skin 

Folliculitis 

Numbness 

Stinging 

Intracranial hypertension  

Acneform lesions 

Pigmentation changes 

Black Box Warning

Black Box Warning:  

clobetasol propionate, like other potent topical corticosteroids, has a black box warning for its potential to cause adverse effects such as skin atrophy, striae, telangiectasias, and hypothalamic-pituitary-adrenal (HPA) axis suppression.

It is used for short-term treatment and under close medical supervision, especially in children and patients with hepatic or renal impairment. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

clobetasol propionate is contraindicated in patients who are hypersensitive to clobetasol propionate or to any ingredient in the preparation. It is also contraindicated in patients with known or suspected disorders of the skin that may become infected, and in patients with untreated infections, such as bacterial infections, fungal infections, or viral infections like herpes simplex, chicken pox or vaccinia. Additionally, it should not be used to treat acne, rosacea, perioral dermatitis, or on areas of the skin affected by atrophy.  

Caution: 

• Hypersensitivity: Patients who have a history of hypersensitivity to clobetasol propionate or any other component of the formulation should avoid using this medication. 
• Skin infections: clobetasol propionate should not be used in patients with untreated skin infections, as it may worsen the infection. 
• Skin atrophy: Long-term use of clobetasol propionate can cause skin atrophy, which can be irreversible in some cases. Therefore, the medication should be used with caution and for the shortest possible duration to avoid this adverse effect. 
• Pediatric use: clobetasol propionate should be used with caution in children as their skin is more permeable and may absorb higher amounts of the medication, leading to increased risk of side effects. 
• Pregnancy and breastfeeding: The safety of clobetasol propionate during pregnancy and breastfeeding is not well established.

Comorbidities: 

• Diabetes: Corticosteroids may increase blood sugar levels and worsen diabetes control. 
• Hypertension: clobetasol propionate can cause sodium and water retention, leading to an increase in blood pressure, especially in people already diagnosed with hypertension. 
• Osteoporosis: Long-term use of corticosteroids, including clobetasol propionate, particularly in postmenopausal women. 
• Glaucoma and cataracts: The prolonged use of high-potency topical corticosteroids such as clobetasol propionate can lead to increased intraocular pressure, increasing the risk of glaucoma and cataracts. 
• Infections: Topical corticosteroids such as clobetasol propionate can mask the symptoms of infections, making it difficult to diagnose and treat them. 
• Liver or kidney disease: clobetasol propionate is primarily metabolized by liver and excreted in the urine; therefore, it may not be recommended or may require close monitoring in individuals with significant liver or kidney disease. 

Pregnancy / Lactation

Pregnancy consideration: Pregnancy Category C 

Lactation: safety and efficacy not established  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

clobetasol propionate is a highly potent synthetic corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive properties. It exerts its effects by binding to intracellular glucocorticoid receptors and stimulating the transcription of certain genes that mediate the anti-inflammatory and immunosuppressive actions of the drug.

clobetasol propionate has a high affinity for the glucocorticoid receptor and a prolonged duration of action due to its high lipophilicity. Corticosteroids like clobetasol propionate have multiple effects on various cell types, including reducing inflammation and immune responses, suppressing the proliferation and differentiation of keratinocytes, and inhibiting the synthesis and release of inflammatory mediators like prostaglandins and leukotrienes.  

Pharmacodynamics: 

clobetasol propionate is a high-potency topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive properties. It exerts its pharmacological effects by binding to glucocorticoid receptors, leading to the activation or repression of various genes and modulation of various cellular responses. 

clobetasol propionate acts by suppressing the immune response and inflammation by inhibiting the production and release of inflammatory cytokines, chemokines, and other mediators. It also reduces the accumulation of leukocytes in the affected area and inhibits the activity of phospholipase A2, which is involved in the synthesis of inflammatory mediators. 

clobetasol propionate also has antipruritic activity by reducing the activity of sensory nerve fibers and reducing the release of histamine and other pruritogens. 

Additionally, clobetasol propionate has vasoconstrictive activity, which helps to reduce the inflammation and edema associated with skin disorders. It achieves this by constricting the blood vessels in the affected area, reducing blood flow and therefore reducing the swelling and redness.  

Pharmacokinetics: 

Absorption 

The absorption of clobetasol propionate through the skin is influenced by factors such as skin hydration, occlusion, and the size of the applied area. It can also be affected by the formulation of the topical preparation. The absorption is enhanced when applied to areas with thin skin, such as the face and neck.  

Distribution 

Once absorbed, clobetasol propionate is distributed throughout the body, including the skin, where it exerts its anti-inflammatory effects. It has a high affinity for corticosteroid receptors and binds to them with high specificity.  

Metabolism 

clobetasol propionate is metabolized in the liver to inactive metabolites, which are excreted in the urine.  

Elimination and excretion 

The elimination half-life of clobetasol propionate is approximately 2 hours. It is eliminated primarily by renal excretion, with a small amount excreted in the feces. 

Overall, the pharmacokinetic profile of clobetasol propionate is consistent with that of other topical corticosteroids. However, due to its high potency, it is recommended to use the lowest effective dose for the shortest duration possible to minimize the risk of systemic side effects. 

Adminstartion

Administration: 

clobetasol propionate is available in various formulations such as creams, ointments, lotions, and solutions. It can be applied topically to the affected area, usually once or twice daily.

The dose and duration may depend on the condition being treated and the severity of symptoms. It is also advised to avoid using the medication on open wounds or broken skin, and to avoid getting it into the eyes or mouth. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: Clobetasol  

Pronounced: [ kloe-bay-ta-sol]  

Why do we use clobetasol propionate? 

clobetasol propionate is a topical corticosteroid that is used to treat various skin conditions, including eczema, psoriasis, lichen sclerosus, and other inflammatory skin disorders. It is available in different forms such as cream, ointment, solution, and foam. 

clobetasol propionate cream and ointment are usually applied to the damaged area once or twice a day, while the solution and foam forms are usually applied once daily. 

clobetasol propionate is generally used for short-term treatment of skin conditions, and not recommended for long-term use due to the risk of side effects such as skin thinning, stretch marks, and increased susceptibility to infections.