Clobetasol propionate

The bundle has since been re-fetched and the eMC arm is now 'CLARELUX 500 micrograms/g cutaneous foam in pressurised container' (medicines.org.uk/emc/product/3392/smpc), applied to the affected area. Its regimen is independently corroborated by the US openFDA label for clobetasol propionate ointment ('apply a thin layer to the affected skin areas twice daily and rub in gently and completely... treatment should be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used'), so the twice-daily / 2-week / 50 g-per-week regimen is consistent across both a UK and a US presentation. FORMULATION CAVEAT: the UK source is a FOAM. It must not be used on the face, is contraindicated in infants under 2 years, and must not be applied to the eyelids (risk of glaucoma and cataract). Cream, ointment and scalp-application presentations have their own SPCs and application instructions, which are not covered by this source. POTENCY AND DURATION: clobetasol propionate belongs to the most potent class of topical corticosteroids (group IV) and prolonged use may result in serious undesirable effects. If treatment with a local corticosteroid is clinically justified beyond 2 weeks, a less potent corticosteroid preparation should be considered. Repeated but short courses may be used to control exacerbations provided the patient is under regular medical supervision. Upon clearing of lesions, or after a maximum treatment period of two weeks, change to intermittent therapy or consider replacing with a weaker steroid. Long-term continuous topical therapy should be avoided, as adrenal suppression can occur readily even without an occlusive dressing; abrupt withdrawal may result in glucocorticosteroid insufficiency, so withdraw gradually by reducing the frequency of application or by substituting a less potent corticosteroid. The label states CLARELUX is a 'very strong steroid'. LONG-TERM USE: cases of osteonecrosis, serious infections (including necrotising fasciitis) and systemic immunosuppression (sometimes resulting in reversible Kaposi's sarcoma lesions) have been reported with long-term use beyond the recommended doses. PAEDIATRIC: CLARELUX is not recommended for use in children less than 12 years old and is contraindicated in infants under 2 years of age; no per-kg or paediatric dose is stated, hence paedDose is null. The US ointment label likewise states that use in paediatric patients under 12 years of age is not recommended, and that children are at greater risk of HPA axis suppression and Cushing's syndrome because of a higher ratio of skin surface area to body mass. GERIATRIC (US label): safety did not differ from younger patients and no dosage adjustment is recommended. eMC section 4.4 was truncated at the source-fetch limit, and neither source in this bundle carried a drug-interactions section.