urticaria
† non-FDA-approved indication
Clobetasol (Temovate) Indications and Dosage
General Comparative Topical Corticosteroid Potency:
NOTE: The following is a general representation. Check specific product formulations prior to making potency decisions.
Very High Potency
Betamethasone dipropionate (augmented)
Clobetasol
Diflorasone diacetate ointment
Halobetasol
High Potency
Amcinonide
Betamethasone dipropionate
Desoximetasone gel or ointment, or cream >= 0.25%
Diflorasone diacetate cream
Fluocinolone cream >= 0.2%
Fluocinonide
Halcinonide
Triamcinolone >= 0.5%
Medium Potency
Beclomethasone
Betamethasone benzoate
Betamethasone valerate
Clobetasone
Desoximetasone cream < 0.25%
Diflucortolone
Fluocinolone ointment or topical solution or cream < 0.2%
Flurandrenolide >= 0.025%
Fluticasone
Hydrocortisone butyrate
Hydrocortisone valerate
Mometasone
Triamcinolone < 0.5%
Low Potency
Alclometasone
Clocortolone
Desonide
Dexamethasone
Flumethasone
Flurandrenolide < 0.025%
Hydrocortisone base
Hydrocortisone acetate
For the treatment of moderate-to-severe inflammatory manifestations, including pruritus, of corticosteroid-responsive dermatologic disorders such as alopecia areata, atopic dermatitis, contact dermatitis, generalized exfoliative dermatitis, Rhus dermatitis due to plants like poison ivy, seborrheic dermatitis, eczema (including severe hyperkeratotic eczema, severe nummular eczema, and severe eczematous conditions of the hands or feet), granuloma annulare, keloids, cutaneous lichen planus, lichen simplex chronicus, lichen striatus, subacute cutaneous and discoid lupus erythematosus, pretibial myxedema, necrobiosis lipoidica diabeticorum, pemphigoid, pemphigus, pityriasis rosea, sarcoidosis, sunburn, or urticaria:
NOTE: Acute exudative inflammation, as occurs with poison ivy, may be best treated with a non-emollient cream or gel formulation, which are drying. Dry, scaly dermatoses may be best treated with emollient creams or ointments. Lower potency corticosteroids should be used on the face and intertriginous areas.
NOTE: Systemic therapy or intralesional injection of corticosteroids may be necessary for some conditions based on the type and severity of the disorder or inadequate response to topical therapy.
Topical dosage (cream, gel, or ointment):
Adults and adolescents: Apply a thin layer to the affected skin areas twice daily, in the morning and in the evening. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used.
Children † : In one study, the cream was applied once daily to the affected areas without occlusion for the treatment of atopic dermatitis. Clobetasol propionate treatment at this dose was associated with a fall in serum cortisol levels. In another small trial, clobetasol butyrate 0.05% cream (not available in the US) applied to the atopic areas twice daily for 4 weeks was reported effective. Urinary cortisol excretion was not altered by the clobetasol butyrate treatment, which was compared to fluticasone propionate 0.05% cream.
Topical dosage (emollient cream):
Adults and adolescents: Apply a thin layer to the affected skin areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks if the body surface area treated is > 10%. If the body surface area treated is 5 - 10%, treatment can be extended to no more than 4 consecutive weeks. Amounts greater than 50 g per week should not be used.
Topical dosage (scalp solution):
Adults and adolescents: Apply to the affected scalp areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 ml per week should not be used.
Topical dosage (foam):
Adults and adolescents >= 12 years: Apply to the affected areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 g (1/2 of the contents of a 100 g can) per week should not be used.
for the treatment of plaque-type psoriasis:
Topical dosage (cream, gel, or ointment):
Adults and adolescents: Apply a thin layer to the affected skin areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used.
Topical dosage (emollient cream):
Adults and adolescents: Apply a thin layer to the affected skin areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks if the body surface area treated is > 10%. If the body surface area treated is 5 - 10%, treatment can be extended to 4 consecutive weeks. Amounts greater than 50 g per week should not be used. In one study of 35 patients, use of 0.4 - 0.5 gm twice daily of clobetasol propionate emollient cream was significantly more effective than the emollient vehicle alone in reducing symptoms after 4 weeks of treatment and at the 2 week post-treatment follow-up period. No significant adverse events were noted.
Topical dosage (scalp solution):
Adults and adolescents >= 12 years: Apply to the psoriatic scalp areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 ml per week should not be used.
Topical dosage (foam):
Adults and adolescents >= 12 years: Apply to the psoriatic areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 g (1/2 of the contents of a 100 g can) per week should not be used.
for the alternative treatment of recalcitrant oral vesiculoerosive disease † including oral lichen planus † , mucous membrane pemphigus † , aphthous ulcer † and chronic oral erythema multiforme † :
Topical dosage (Dental topical preparation † of clobetasol ointment in Orabase™):
Adults: Apply a thin coating directly to the lesion(s) twice daily until signs and symptoms have receded. In one double-blind clinical trial, 55 patients were treated up to 4 weeks with either clobetasol propionate or fluocinonide ointment in Orabase™. Both medications provided relief of pain and erythema, and decreased lesion size. Common side effects included oral candidiasis, hypogeusia, and burning sensation at the site of application.
For the treatment of vulvar lichen sclerosus † :
Topical dosage (cream):
Adult females: Apply a thin layer to the affected vulvar, labial, and perineal areas twice daily, once in the morning and once at night. Treatment must be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used. In a retrospective, uncontrolled analysis of 36 women with biopsy-proven lichen sclerosis, the initial clobetasol treatment course provided remission of symptoms in 77% of patients, and 47% noted an improvement in tissue appearance at one year of follow-up. The authors noted that intermittent clobetasol applications may be needed to maintain results.
For the alternative treatment of vision-threatening periocular capillary hemangioma † in infancy and early childhood:
Topical dosage (cream):
Children and Infants: Limited reports have used topical clobetasol propionate cream as an alternative to intralesional corticosteroid injections. Treatment was prescribed with 0.05% clobetasol propionate cream applied to the area twice daily for 2 weeks, followed by a 1-week intermission. The cycle was repeated as needed. The 3 cases responded within 4 months to the topical treatment. Children were closely monitored for adrenal suppression. Clobetasol application was reserved for instances in which the risks of the disease (e.g., permanent visual loss) to the infant or the young child outweighed the potential risks of clobetasol treatment. Because the involution of the hemangioma occurs at a slower rate than would intralesional injection, topical clobetasol would not be appropriate in instances of acute, severe visual axis occlusion.
Maximum Dosage Limits:
