clobetasone

Action and Spectrum

Actions and Spectrum: 

clobetasone is a synthetic corticosteroid used topically to treat various inflammatory skin conditions. It has anti-inflammatory, anti-itching, and vasoconstrictive properties.  

Action: 

• Anti-inflammatory: clobetasone acts by suppressing inflammation through various mechanisms. It inhibits producing inflammatory mediators like prostaglandins and leukotrienes, thereby reducing redness, swelling, and itching associated with inflammatory skin conditions. 
• Immunomodulatory effects: clobetasone has immunomodulatory effects that help regulate the immune response in the affected skin area. It reduces the release of inflammatory cytokines and inhibits the migration of immune cells to the site of inflammation. 

Spectrum:  

• Eczema: It can alleviate symptoms of various types of eczema, together with atopic dermatitis, allergic contact dermatitis, and seborrheic dermatitis. 
• Psoriasis: clobetasone can help reduce the inflammation, redness, and scaling associated with psoriasis. 
• Dermatitis: It is effective in treating different forms of dermatitis, such as irritant dermatitis and allergic dermatitis. 
• Pruritus: clobetasone can relieve itching caused by various skin conditions. 
• Other inflammatory skin disorders may also treat conditions like lichen planus, discoid lupus erythematosus, and insect bite reactions. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Erythema of skin 

Burning sensation on the skin  

Local hypersensitivity reaction 

Skin irritation 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

Like any medication, clobetasone has specific contraindications, which are conditions or situations where drug use is not recommended due to potential risks or interactions.  

• Hypersensitivity: clobetasone should not be used in individuals with known hypersensitivity or allergic reactions to clobetasone or other corticosteroids. Allergic reactions can vary from mild skin irritation to severe anaphylaxis, a life-threatening allergic reaction. 
• Skin infections: clobetasone should not be used on skin areas affected by infections, such as bacterial, viral (e.g., herpes simplex, chickenpox), or fungal infections. Using corticosteroids on infected skin can exacerbate the infection and hinder its healing process. 
• Rosacea and acne: clobetasone is generally not recommended for use in individuals with rosacea or acne, as it may worsen or cause adverse effects. 
• Perioral dermatitis: clobetasone is contraindicated in perioral dermatitis, a skin condition characterized by a rash around the mouth. The use of topical corticosteroids can lead to the worsening of the condition. 
• Tuberculosis: Systemic corticosteroids, including clobetasone, should not be used in individuals with active tuberculosis (TB) without appropriate anti-TB therapy. Corticosteroids can suppress the immune system and potentially exacerbate the infection. 
• Vaccination: clobetasone should be avoided in individuals about to receive live or attenuated live vaccines. Corticosteroids can weaken the immune response to vaccines and reduce their effectiveness. 

Caution 

While clobetasone is generally considered safe and effective when used as directed, there are certain precautions to be aware of before using this drug.  

• Long-term use: Prolonged or excessive use of clobetasone, especially on large body areas or under occlusive dressings, may increase the risk of systemic medication absorption. This can lead to potential systemic side effects of corticosteroids, such as adrenal suppression, Cushing’s syndrome, and metabolic disturbances. Therefore, following the recommended dosage and duration of treatment as prescribed by your healthcare professional is crucial. 
• Thin or damaged skin: clobetasone should be used cautiously on delicate or damaged skin areas, such as the face, armpits, groin, or areas with skin folds. Corticosteroids can further thin the skin and increase the risk of skin atrophy, telangiectasia (dilation of blood vessels), and delayed wound healing. 
• Interactions with other medications: Inform your healthcare professional about all the medications you are currently taking, including prescription, over-the-counter drugs, and herbal supplements. Some medications may interact with clobetasone, potentially affecting its effectiveness or increasing the risk of side effects. 
• Pediatric use: clobetasone can be used in children under medical supervision. However, prolonged or excessive use in children, particularly on their faces or areas with thin skin, should be avoided, as they may be more susceptible to systemic absorption and adverse effects. 
• Pregnancy and breastfeeding: The use of clobetasone during pregnancy or breastfeeding should be discussed with a healthcare professional. While topical corticosteroids are generally considered safe during pregnancy and breastfeeding when used according to medical advice, the potential risks and benefits should be evaluated. 
• Eye contact: clobetasone should not be applied directly to or near the eyes. If accidental contact occurs, rinse the eyes thoroughly with water and seek medical attention if necessary. 
• Discontinuation: Abruptly stopping clobetasone after prolonged use may lead to a rebound flare-up of the treated condition. It is generally recommended to gradually reduce the frequency and strength of the application as advised by your healthcare professional. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

clobetasone is a synthetic corticosteroid with potent anti-inflammatory and immunomodulatory properties. It binds to glucocorticoid receptors within target cells, inhibiting the production of pro-inflammatory mediators, like prostaglandins and leukotrienes. This reduces inflammation, redness, swelling, and itching associated with various inflammatory skin conditions.

clobetasone also exerts immunosuppressive effects by modulating the immune response, suppressing the release of inflammatory cytokines, and inhibiting the migration of immune cells to the site of inflammation. Its pharmacological actions help alleviate symptoms and improve the skin’s overall condition in patients with eczema, psoriasis, dermatitis, pruritus, and other inflammatory skin disorders. 

Pharmacodynamics: 

Mechanism of action: The action of clobetasone, a synthetic corticosteroid, involves its binding to glucocorticoid receptors within target cells.  

• Receptor binding: clobetasone diffuses into the target cells and binds to glucocorticoid receptors in the cytoplasm. This binding causes a conformational change in the receptor, activating it. 
• Nuclear translocation: Upon activation, the clobetasone-bound glucocorticoid receptor complex moves into the cell nucleus, binding to specific DNA sequences called glucocorticoid response elements (GREs) within the promoter regions of target genes. 
• Gene expression regulation: The binding of the clobetasone-glucocorticoid receptor complex to GREs modulates gene expression. Depending on the target gene and the cell type, it can either enhance or suppress the transcription of specific genes. The activated complex acts as a transcription factor, influencing the production of various proteins involved in inflammation, immune response, and other cellular processes. 
• Anti-inflammatory effects: clobetasone’s primary action is to suppress inflammation. It inhibits the expression of pro-inflammatory genes, such as those encoding cytokines (e.g., interleukins), chemokines, and enzymes involved in producing inflammatory mediators (e.g., cyclooxygenase-2). This reduces the synthesis and release of inflammatory substances, resulting in decreased redness, swelling, and itching associated with inflammatory skin conditions. 
• Immunomodulation: clobetasone also exerts immunomodulatory effects. It can suppress the activity of immune cells, including macrophages, T cells, and mast cells. This dampens the immune response and decreases the release of inflammatory cytokines, thereby further reducing inflammation. 

Pharmacokinetics: 

Absorption 

When applied topically to the skin, clobetasone is absorbed through the skin barrier into the underlying tissues. The extent of absorption depends on various factors, such as the integrity of the skin, the formulation of the medication, the surface area of application, and the use of occlusive dressings. Absorption is generally higher when applied to areas with thinner skin, such as the face and genital regions. 

Distribution 

Once absorbed into the skin, clobetasone binds to proteins, such as albumin, in the blood, facilitating its distribution to various tissues. However, the systemic distribution of clobetasone following topical application is limited due to its high affinity for local tissue glucocorticoid receptors. 

Metabolism 

clobetasone undergoes metabolism primarily in the liver. Various enzymatic processes metabolize it, including oxidation, reduction, and conjugation reactions. The primary metabolites include inactive compounds, such as 20β-dihydroclobetasone and 20β-dihydroclobetasol, which are metabolized and ultimately eliminated from the body. 

Elimination and Excretion 

The metabolites of clobetasone and a small portion of the unchanged drug are excreted primarily in urine and, to a fewer extent, in feces. The elimination half-life of clobetasone is relatively short, typically ranging from a few hours to several hours. 

Adminstartion

Administration: 

clobetasone is a topical corticosteroid typically available as a cream, ointment, or lotion.  

• Clean the affected area: Before applying clobetasone, gently clean it with mild soap and water, and pat it dry. It is vital to have clean, dry skin before applying the medication. 
• Apply a thin layer: Take a small amount of clobetasone (usually a pea-sized amount) and apply it in a thin layer to the affected area. Gently rub it into the skin till it is absorbed. Avoid applying excessive amounts, as this does not enhance the effectiveness and may increase the risk of side effects. 
• Wash hands after application: After applying the medication, wash your hands completely to remove any residual product. 
• Frequency of application: The frequency of application and duration of therapy will be generally based on the specific condition being treated and the instructions provided by your healthcare professional. Generally, clobetasone is applied once or twice daily. Follow the recommended dosing schedule and duration of treatment as prescribed. 
• Avoid getting clobetasone cream or ointment into your eyes, mouth, or other mucous membranes. If accidental contact occurs, rinse the area with water immediately. 
• Do not cover with airtight dressings unless directed: Unless specifically instructed by your healthcare professional, it is generally unnecessary to cover the treated area with airtight dressings. However, non-occlusive dressings, such as breathable bandages, can be used if directed. 
• Follow the complete treatment course: It is crucial to complete the prescribed course of treatment, even if the symptoms improve. Abruptly stopping clobetasone may cause a rebound flare-up or incomplete resolution of the condition. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: clobetasone 

Why do we use clobetasone? 

clobetasone is a topical corticosteroid used to treat various inflammatory skin conditions.  

• Eczema: clobetasone is often prescribed to alleviate symptoms associated with different types of eczema, including atopic dermatitis, allergic contact dermatitis, and seborrheic dermatitis. It helps reduce itching, redness, inflammation, and skin irritation. 
• Psoriasis: clobetasone can be used to manage symptoms of psoriasis, a chronic skin condition generally characterized by red, scaly patches on the skin. It helps reduce inflammation, scaling, and itching associated with psoriatic lesions. 
• Dermatitis: clobetasone effectively treats various forms of dermatitis, including irritant and allergic dermatitis. It helps relieve symptoms such as itching, redness, swelling, and skin irritation caused by these conditions. 
• Pruritus: clobetasone may be prescribed to relieve itching caused by different skin conditions, including eczema, psoriasis, dermatitis, and insect bite reactions. It helps reduce the itching sensation and provides relief. 
• Lichen Planus: clobetasone can manage lichen planus, an inflammatory skin condition characterized by itchy, flat-topped, purple-colored bumps or rashes. It helps reduce inflammation, itching, and discomfort associated with lichen planus lesions. 
• Discoid Lupus Erythematosus: clobetasone is sometimes prescribed to treat discoid lupus erythematosus, a chronic autoimmune skin condition. It helps reduce inflammation, redness, and scaling associated with discoid lupus lesions. 
• Insect Bite Reactions: clobetasone may alleviate itching, redness, and inflammation caused by insect bite reactions. It helps provide relief and reduce the inflammatory response in the affected area.