clobetasol


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clobetasol

 [klo-ba´tah-sol]
a synthetic corticosteroid used topically as the salt for the relief of inflammation and pruritus in corticosteroid-responsive dermatoses.

clobetasol

(kloe-bay-ta-sol) ,

Clobex

(trade name),

Dermovate

(trade name),

Temovate

(trade name),

Temovate E

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Management of inflammation and pruritis associated with various allergic/immunologic skin problems.

Action

Suppresses normal immune response and inflammation.

Therapeutic effects

Suppression of dermatologic inflammation and immune processes.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may increase systemic absorption.
Distribution: Remains primarily at site of action.
Metabolism and Excretion: Usually metabolized in skin; may be modified to resist local metabolism and have a prolonged local effect.
Half-life: Unknown.

Time/action profile (response depends on condition being treated)

ROUTEONSETPEAKDURATION
Topicalmin–hrshrs–dayshrs–days

Contraindications/Precautions

Contraindicated in: Hypersensitivity or known intolerance to corticosteroid or components of vehicles (ointment or cream base, preservative, alcohol); Untreated bacterial or viral infections.
Use Cautiously in: Hepatic dysfunction; Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition); Patients with pre-existing skin atrophy; Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children (chronic high-dose use may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression); Not recommended for use in children <12 yr.

Adverse Reactions/Side Effects

Dermatologic

  • allergic contact dermatitis
  • atrophy
  • burning
  • dryness
  • edema
  • folliculitis
  • hypersensitivity reactions
  • hypertrichosis
  • hypopigmentation
  • irritation
  • maceration
  • miliaria
  • perioral dermatitis
  • secondary infection
  • striae

Miscellaneous

  • adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Topical (Adults and Children) Apply to affected area(s) 1–3 times daily (depends on preparation and condition being treated).

Availability (generic available)

Cream: 0.05%
Emollient cream: 0.05%
Foam: 005%
Gel: 0.05%
Lotion: 0.05%
Ointment: 0.05%
Scalp solution: 0.05%
Shampoo: 0.05%
Spray: 0.05%

Nursing implications

Nursing assessment

  • Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
    • May cause increased serum and urine glucose concentrations if significant absorption occurs.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments. Solution, spray, and shampoo are useful in hairy areas.
  • Topical: Apply ointment, creams, gel, or lotion sparingly as a thin film to clean skin. Wash hands immediately after application. Apply occlusive dressing only if specified by health care professional.
    • Apply solution and shampoo to hair by parting hair and applying a small amount to affected area. Rub in gently. With solution, protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not right after applying medication. With shampoo, wash hair as usual 15 minutes after application.
    • Apply spray sparingly as a thin film to clean, dry skin. Wash hands immediately after application.

Patient/Family Teaching

  • Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for the next dose.
  • Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
  • Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
  • Caution women that medication should not be used extensively, in large amounts, or for protracted periods if they are pregnant or planning to become pregnant.
  • Advise patient to consult health care professional before using medicine for condition other than indicated.
  • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.

Evaluation/Desired Outcomes

  • Resolution of skin inflammation, pruritus, or other dermatologic conditions.

clobetasol

A powerful steroid drug used for external application in severe dermatological disorders. Brand names are Dermovate and Eumovate.
References in periodicals archive ?
A study compared the therapeutic effects of clobetasol and topical tacrolimus on vitiligo, reported the equal efficacy of both medications, while more complications were mentioned in those treated with clobetasol.6 In another study, the therapeutic effects of mometasone with pimecrolimus were compared, both treatments led to nearly similarly decrease in size of vitiligo lesions.9
Biopsy was consistent with LS, and he was prescribed treatment with clobetasol propionate 0.05% ointment two times a day for a month, then once a day until the follow-up visit scheduled for 3 months after the initial visit.
Conclusion: The frequency of serum cortisol suppression was significantly higher amongst patients using clobetasol propionate 0.05%.
Clobetasol alone was the most frequently used agent responsible in 13(72%) cases; Clobaderm ointment in 8(44.4%) and Dermovat in 5(27.7%).
After screening 727 potential drug candidates, they identified two - miconazole and clobetasol - that coaxed the OPCs to form oligodendrocytes and repair nerve fibres stripped of myelin.
Clobetasol propionate cream is an analog of prednisolone with high degree of glucocorticoid activity and a slight degree of mineralocorticoid activity that is widely used to treat dermatologic diseases.
Treatment options for localized /limited LPP include intralesional triamcinolone acetonide and/or several treatments at home, including 0.05% clobetasol propionate lotion or foam, clobetasol propionate shampoo to help decrease itching and burning, fluocinolone acetonide oil one time per week to help with removal of scales, and topical 0.1% tacrolimus ointment (or compounded lotion) as needed.
has received Food and Drug Administration approval for its Abbreviated New Drug Application for clobetasol propionate shampoo, 0.05%, the generic equivalent of Clobex shampoo.
She advises gaining familiarity with the use of desonide, triamcinolone 0.1%, and clobetasol.
Clobetasol propionate, (11p,16P)-21-chloro-9-fluoro-11-hydroxy-16-methyl-17-(1-oxopropoxy)-pregna- 1,4-diene-3,20-dione, is a synthetic corticosteroid normally indicated for topical dermatologic use.
Researchers from the Hospital Saint Louis, Paris analysed a group of 46 people and identified two with insufficient adrenal gland function that was due to use of clobetasol, which is illegal in France.