Clobetasone butyrate

PRIOR HOLD RESOLVED: the previous verification could not read the source bundle and left two questions open — whether the duration figures were real, and whether a maximum weekly quantity had been dropped from maxDose. The bundle is now readable (eMC 'Eumovate Cream', medicines.org.uk/emc/product/3807/smpc) and both are settled: the 4-week adult limit and 7-day paediatric limit are stated verbatim in section 4.2, and the SPC states NO maximum weekly quantity (unlike the clobetasol propionate presentations in this batch, which carry a 50 g/week ceiling). maxDose is therefore correctly absent rather than missing. DURATION FOR ADULTS AND ELDERLY: continuous daily treatment for longer than four weeks is not recommended; if the condition worsens or does not improve within four weeks, treatment and diagnosis should be re-evaluated. DISCONTINUATION: therapy with topical corticosteroids should be gradually discontinued once control is achieved, with an emollient continued as maintenance therapy — rebound of pre-existing dermatoses can occur with abrupt discontinuation, especially with potent preparations. PAEDIATRIC (from the SPC, non-numeric — hence paedDose is null): use in children under 12 years should be on the advice of a doctor; care should be taken to ensure the amount applied is the minimum that provides therapeutic benefit; when used in the treatment of dermatoses in children, extreme caution is required and treatment should not normally exceed 7 days; if the condition worsens or does not improve within 7 days, treatment should be reviewed; once the condition has been controlled, the frequency of application should be reduced to the lowest effective dose for the shortest time possible; continuous daily treatment for longer than 4 weeks is not recommended in children. Children and infants may absorb proportionally larger amounts of topical corticosteroids than adults and are more susceptible to systemic adverse effects because of their higher surface area to body mass ratio; in infants and toddlers the nappy can be considered an occlusive dressing and can enhance absorption; in infants and children under 12 years long-term continuous topical corticosteroid therapy should be avoided where possible, as adrenal and growth suppression is more likely. ELDERLY: clinical studies have not identified differences in response between elderly and younger patients, but the greater frequency of decreased hepatic or renal function in the elderly may delay elimination if systemic absorption occurs, so the minimum quantity should be used for the shortest duration. SITE CAUTIONS: prolonged application to the face is undesirable, as this area is more susceptible to atrophic changes; if applied to the eyelids, care is needed to ensure the preparation does not enter the eye, as cataract and glaucoma might result from repeated exposure. Bacterial infection is encouraged by the warm, moist conditions within skin folds or under occlusive dressings, and the skin should be cleansed before a fresh dressing is applied. eMC section 4.4 was truncated at the source-fetch limit; no section 4.5 interactions section was captured, and the openFDA and WHO arms of this bundle are null.