Topical Glucocorticoid·Dermatology - Topical Corticosteroids

Clobetasol

Recalcitrant severe psoriasis, lichen planus, discoid lupus, severe vulvar lichen sclerosus

Authority requiredPBSSTEROIDDermol, DermovateCream/Ointment 0+2

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At a glance

Max Dose

14 g / WEEK

High risk: Potency

ULTRA-POTENT

Caution: Max Use

<=2 WEEKS

High risk: Adrenal Supp.

HIGH RISK

Cautions

Avoid / Cautions

Face, groin, axillae. Children < 12 years. Widespread use over large body surface areas. Occlusive dressings. Pregnancy Category C. (Avoid. High risk of systemic fetal exposure).

Where it stands

Rapid Summary

Overview

Ultra-potent topical corticosteroid (Class I / Super-Potent). Up to 600 times stronger than hydrocortisone. The absolute strongest topical steroid in human medicine.

Clinical Focus

Acts like a systemic oral steroid. Applying more than 50g a week will completely shut down the patient's adrenal glands, causing a fatal Addisonian crisis if stopped abruptly.

Bottom Line

Clobetasol is the most potent (superpotent) topical corticosteroid for severe, resistant dermatoses, but must be limited to 2 weeks maximum and never used on the face due to severe atrophic side effects.

Formulation & Access

Brand Names

Dermol, Dermovate

Topical Routes

Cream/Ointment 0.05%. Scalp application.

Prescribing & PBS

Authority Required (PBS). S4.

Indications & Use

Primary

PBSTGA

Recalcitrant severe psoriasis, lichen planus, discoid lupus, severe vulvar lichen sclerosus.

Clinical Place

The absolute last resort topical therapy. Used to treat conditions that mimic thick leather, where normal drugs bounce off.

Quick reference

Class & Role

Topical Glucocorticoid — Ultra-potent topical corticosteroid (Class I / Super-Potent).

Route / Formulation

Cream/Ointment 0.05%. Scalp application. (Dermol, Dermovate)

Usual Dose & Max

Topical Apply sparingly OD to BD to affected areas only. Max 14 g/week and 2 consecutive weeks; avoid face, scalp, groin, axillae, flexures, occlusion, and children/adolescents <18.

Best Uses

Key Risks

Endocrine: Iatrogenic Cushing's syndrome and severe HPA axis suppression. The adrenal glands go to sleep due to massive systemic absorption. Dermatological: Rapid, irreversible skin atrophy, tearing, bruising, and stretch marks if applied to normal skin.

Key Interactions

Additive immunosuppression with systemic agents.

Monitoring

Weigh the tube. If the patient goes through more than one 50g tube in a week, they are overdosing and their adrenal glands are shut down. Check morning cortisol if prolonged high-dose use is suspected.

Clinical Pearl

If Clobetasol is abruptly stopped after weeks of use on severe psoriasis, the patient will suffer a horrific, full-body 'pustular psoriasis' flare that can be fatal. It must be tapered down to weaker steroids (Betamethasone -> Hydrocortisone) slowly.

Access

Authority requiredDermol, Dermovate

Brand: Dermol, Dermovate
PBS status: Authority required

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