Adult: As 0.05% ointment/cream: Apply thinly and rub gently onto the affected area once daily or bid until improvement occurs. May reduce dose according to response. Max dose: 50 g weekly. Max treatment duration: 4 weeks. As 0.05% lotion/gel: Apply thinly and rub gently onto the affected area bid. Max dose: 50 g weekly. Max treatment duration: 2 weeks. Dosage and treatment duration recommendations may vary among individual products or between countries (refer to detailed product guidelines). Child: >1 year As 0.05% ointment/cream: Same as adult dose. Limit treatment duration to 5 days if possible, and review weekly. <12 years As 0.05% gel: Not recommended.
Topical/Cutaneous Scalp psoriasis
Adult: For moderate to severe cases: As 0.05% shampoo: Apply up to 7.5 mL to dry scalp once daily, leave on for 15 minutes before rinsing thoroughly. Do not cover with a shower cap. Hair may be washed using regular shampoo if needed. Max dose: 50 g (50 mL) weekly. Max treatment duration: 4 weeks. Child: <2 years As 0.05% shampoo: Contraindicated.
Topical/Cutaneous Corticosteroid-responsive dermatoses of the scalp
Adult: As 0.05% scalp solution: Apply sparingly and gently rub onto affected area of scalp once daily or bid (morning and night). Max dose: 50 g weekly. Max treatment duration: 4 weeks. As 0.05% foam: Apply thinly and rub gently on affected area of scalp bid. Max dose: 50 g weekly. Max treatment duration: 2 weeks. Dosage and treatment duration recommendations may vary among individual products or between countries (refer to detailed product guidelines). Child: >1 year As 0.05% scalp solution: Same as adult dose. Limit treatment duration to a few days if possible, and review weekly. <12 years As 0.05% foam: Not recommended.
Contraindications
Hypersensitivity. Treatment of rosacea, perioral dermatitis, acne vulgaris, perianal or genital pruritus; viral lesions of the skin (e.g. herpes simplex or zoster, varicella); bacterial or fungal infection of the skin, parasitic infections, skin symptoms relating to tuberculosis or syphilis, eruptions following vaccinations, burns, ulcerous wounds. Atrophy at treatment site. Primary infections of the scalp (scalp solution). Children <1 year (ointment, cream, scalp solution); <2 years (shampoo).
Special Precautions
Patient with history of local hypersensitivity to other corticosteroids. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Hypothalamic-pituitary-adrenal (HPA) axis suppression or hypercortisolism particularly in younger children (high dose for prolonged treatment); Kaposi sarcoma (prolonged use); allergic contact dermatitis, local effects (e.g. folliculitis, skin atrophy, perioral dermatitis, telangiectasia, acneiform eruptions), skin infections; osteonecrosis (prolonged use); ocular effects (e.g. posterior subcapsular cataracts, glaucoma, central serous chorioretinopathy); systemic effects (e.g. manifestations of Cushing’s syndrome, hyperglycaemia, glycosuria). Rarely, generalised pustular psoriasis (prolonged use in psoriasis). General disorders and administration site conditions: Application site reactions. Nervous system disorders: Headache. Respiratory, thoracic and mediastinal disorders: Nasopharyngitis, upper respiratory tract infection. Skin and subcutaneous tissue disorders: Pruritus, skin dryness, striae, local skin burning sensation, skin pain.
Avoid contact with eyes, eyelids, face, nose, mouth, axillae, or groin. Do not use with occlusive dressing.
Monitoring Parameters
Monitor for HPA axis suppression with prolonged use through ACTH stimulation test, morning plasma cortisol test, and urinary free cortisol test; ocular changes.
Drug Interactions
Increased systemic exposure with CYP3A4 inhibitors (e.g. itraconazole, ritonavir). May diminish the antineoplastic effect of aldesleukin.
Action
Description: Mechanism of Action: Clobetasol is a very potent topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive effects. It promotes induction of phospholipase A2 inhibitory proteins (lipocortins) and subsequently inhibits the release of arachidonic acid, thereby depressing the formation, release, and activity of endogenous chemical mediators of inflammation (e.g. kinins, histamine, leukotrienes, prostaglandins). Pharmacokinetics: Absorption: Variable percutaneous absorption (dependent on dose, integrity of epidermis, vehicle used, and use of occlusive dressing). Metabolism: Metabolised in the liver. Excretion: Via urine and faeces.
Chemical Structure
Clobetasol Source: National Center for Biotechnology Information. PubChem Database. Clobetasol propionate, CID=32798, https://pubchem.ncbi.nlm.nih.gov/compound/Clobetasol-propionate (accessed on Jan. 21, 2020)
Storage
Ointment/cream/gel/lotion/shampoo: Store below 30°C. Do not refrigerate or freeze. Protect from light. Foam/scalp solution: Store below 25°C. Keep away from open flame, heat, and direct sunlight. Do not pierce or burn the foam canister even when empty. Do not refrigerate. Storage recommendations may vary among individual products or between countries (refer to detailed product guidelines).
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