Clobetasol Propionate

How it works

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

Prescribing in practice

• As a very potent steroid it carries a high risk of skin atrophy, striae and systemic absorption with HPA-axis suppression, so use should be limited to short courses and the least amount needed to control disease.
• Avoid on the face, flexures and broken skin, and use with particular caution under occlusion which markedly increases potency and absorption.
• Reserve for severe disease and step down to a less potent steroid once control is achieved, reviewing the diagnosis if there is no response.

Monitoring

Monitor clinically for local steroid-induced skin changes and, with extensive or prolonged use, for signs of systemic corticosteroid effects and adrenal suppression.

Counselling the patient

• Apply a thin film only to the affected areas and do not use it on the face unless specifically told to.
• Do not stop abruptly after prolonged use; follow the prescribed tapering or stepping-down plan.
• Report skin thinning, stretch marks or worsening rash.

Evidence & guidelines

Use is guided by topical corticosteroid potency principles and NICE guidance on managing eczema and psoriasis with the lowest effective potency.