Clobetasol propionate

How it works

It binds intracellular glucocorticoid receptors to suppress inflammatory gene transcription, producing marked anti-inflammatory, immunosuppressive, antiproliferative and vasoconstrictive effects in the skin.

Prescribing in practice

• As a very potent steroid it carries the greatest risk of skin atrophy, striae, telangiectasia and, with extensive or prolonged use, systemic absorption causing adrenal suppression, so it must be used short-term and sparingly.
• Avoid the face, flexures and napkin area unless specifically directed, and avoid use under occlusion except on specialist advice.
• Do not use on untreated skin infection and use with particular caution in children, who are more susceptible to systemic effects.

Monitoring

Monitor the treated skin for atrophy and the clinical response, and consider adrenal function if large areas are treated for prolonged periods.

Counselling the patient

• Apply a thin film only to the affected areas and avoid healthy surrounding skin.
• Do not exceed the duration your prescriber advises, and step down to a milder steroid as the condition improves.
• Report skin thinning, stretch marks or lack of improvement.

Evidence & guidelines

MHRA advice and NICE guidance support short-term use of potent topical corticosteroids with the lowest effective potency and a finite treatment course.