Generic Name

Clobetasol

Mechanism

Clobetasol exerts its therapeutic effect through high‑affinity binding to cytosolic glucocorticoid receptors (GR), forming a clobetasol‑GR complex that translocates to the nucleus. There, it
• Inhibits pro‑inflammatory transcription (e.g., IL‑1, TNF‑α, IL‑6) via glucocorticoid‑response elements (GREs).
• Suppresses phospholipase A₂, reducing arachidonic acid release.
• Downregulates epidermal growth factor and keratocyte differentiation, halting hyperproliferation.

The end result is potent anti‑inflammatory, anti‑pruritic, and anti‑proliferative activity.

Pharmacokinetics

• Absorption: Skin penetration is maximal over compromised or inflamed epidermis; typical systemic absorption  15 % body surface) can lead to clinically detectable cortisol suppression.

Indications

• Atopic eczema, contact dermatitis, psoriasis vulgaris, lichen planus (topical).
• Fungal keratitis and superficial cutaneous mycoses (eye sparing, occlusive dressings).
• Dermatologic conditions of the scalp (alopecia areata, psoriasis).
• Sharp‐edge inflammation (e.g., eczematous flare, post‑operative skin inflammation).
• High‑potency topical use only; systemic use is contraindicated.

Contraindications

• Known hypersensitivity to clobetasol or any excipient.
• Active or untreated infections (bacterial, fungal, viral).
• Children < 6 months (absorption risk).
• Pregnancy & lactation – avoid unless risk outweighs benefit.
• Cushingoid phenotype or evidence of adrenal suppression.
• Use over large burned or moist desquamated skin is discouraged.
• Concomitant immunosuppressants may potentiate systemic side effects.

Dosing

• Ointment/Cream (0.05 %): Apply a thin film (≈ 0.5 g) to affected area 2–4 × daily.
• Duration: Short bursts; limit to 2–4 weeks, then taper or switch to a lower‑potency steroid.
• Apply on clean, dry skin.
• Occlusion is generally avoided; if needed, use for < 3 days to augment absorption.
• Pediatric use: Apply sparingly, avoid face & hairline, monitor for systemic effects.
• Transdermal patches: Not labeled; avoid off‐label uses.

Adverse Effects

Monitoring

• Clinical review: 1–2 weeks after initiation to assess efficacy & local toxicity.
• Adrenocorticotropic hormone (ACTH)/cortisol: Check if extensive surface area (> 15 %, chronic therapy) is used.
• Bone density: For long‑term systemic absorption risk.
• Skin inspection: Watch for atrophy, telangiectasia, or secondary infections.
• Adjunct therapy: Assess need for barrier repair creams or moisturizers.

Clinical Pearls

• Thin Coat Rule – A single “paper‑thin” layer of ointment is adequate; excess increases systemic absorption without added benefit.
• Face & Intertriginous Areas – Reserve for short courses; switch to a milder steroid (e.g., 0.1 % tixocortolone) for long‑term maintenance.
• Pediatric “Rule of 10” – Limit cumulative dose to < 1 mg prednisone‑equivalent per day for < 12 yrs.
• Patch Test – Perform a small‑spot test on unaffected skin before widespread application, especially in patients with atopic dermatitis.
• Febrile/Surgical Cases – Avoid clobetasol on surgical or burn wounds; choose a milder agent for inflammation control.
• Adjunctive Moisturizer – A non‑emollient barrier cream improves efficacy and decreases transepidermal drug loss.
• Reporting Adverse Events – Clinicians should document local atrophy or systemic signs in pharmacovigilance databases to refine safety profiles.

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• *References omitted for brevity – all information compiled from current pharmacopeia, FDA product labeling, and peer‑reviewed dermatologic guidelines.*