Clobetasol propionate

Clobetasol propionate is a corticosteroid used to treat skin conditions such as eczema, contact dermatitis, seborrheic dermatitis, and psoriasis.[2] It is applied to the skin as a cream, ointment, or shampoo.[2][3] Use should be short term and only if other weaker corticosteroids are not effective.[3] Use is not recommended in rosacea or perioral dermatitis.[2]

Not to be confused with Clostebol propionate.
Clobetasol propionate
Clinical data
Pronunciation/kloʊˈbeɪtəsɒl/[1]
AHFS/Drugs.comMonograph
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    administration    		Topical only
    ATC code
    Legal status
    Legal status
    • In general: ℞ (Prescription only)
    Identifiers
    CAS Number
    PubChem CID
    IUPHAR/BPS
    DrugBank
    ChemSpider
    UNII
    ChEBI
    ChEMBL
    CompTox Dashboard (EPA)
    ECHA InfoCard100.042.380
    Chemical and physical data
    FormulaC25H32ClFO5
    Molar mass466.97 g/mol g·mol−1
    3D model (JSmol)
      (verify)

    Common side effects include skin irritation, dry skin, redness, pimples, and telangiectasia.[2] Serious side effects may include adrenal suppression, allergic reactions, cellulitis, and Cushing's syndrome.[2] Use in pregnancy and breastfeeding is of unclear safety.[4] Clobetasol is believed to work by activating steroid receptors.[2] It is a US Class I (Europe: class IV) corticosteroid, making it one of the strongest available.

    Clobetasol propionate was patented in 1968 and came into medical use in 1978.[5] It is available as a generic medication.[3] A month supply in the United Kingdom costs the NHS about 7.90 £ as of 2019.[3] In the United States the wholesale cost of this amount is about 66 USD.[6] In 2016 it was the 184th most prescribed medication in the United States with more than 3 million prescriptions.[7]

    Medical uses

    Clobetasol propionate is used for the treatment of various skin disorders including eczema, herpes labialis,[8] psoriasis, and lichen sclerosus. It is also used to treat several auto-immune diseases including alopecia areata, lichen planus (auto immune skin nodules), and mycosis fungoides (T-cell skin lymphoma). It is used as first-line treatment for both acute and chronic GVHD of the skin.[9]

    Clobetasol propionate is used cosmetically by dark-skinned women for skin whitening, although this use is controversial. The U.S. Food and Drug Administration has not approved it for that purpose, and sales without a prescription are illegal in the U.S. Nonetheless, skin-whitening creams containing this ingredient can sometimes be found in ethnic beauty supply stores in New York City and on the internet. It is also sold internationally, and does not require a prescription in some countries. Whitening creams with clobetasol proprionate, such as Hyprogel, can make skin thin and easily bruised, with visible capillaries, and acne. It can also lead to hypertension, elevated blood sugar, suppression of the body's natural steroids, and stretch marks, which may be permanent.[10]

    Clobetasol propionate is, along with mercury and hydroquinone, "amongst the most toxic and most used agents in lightening products." Many products sold illegally have higher concentrations of clobetasol propionate than is permitted for prescription drugs.[11]

    Contraindications

    According to the California Environmental Protection Agency, clobetasol propionate should not be used by pregnant women, or women expecting to become pregnant soon, as studies with rats shows a risk of birth defects:[12]

    "Studies in the rat following oral administration at dosage levels up to 50 mcg/kg per day revealed that the females exhibited an increase in the number of resorbed embryos and a decrease in the number of living fetuses at the highest dose. Pregnancy: Teratogenic Effects (i.e., possibility of causing abnormalities in fetuses): Pregnancy Category C: Clobetasol propionate has not been tested for teratogenicity when applied topically; however, it is absorbed percutaneously, and when administered subcutaneously it was a significant teratogen in both the rabbit and mouse. Clobetasol propionate has greater teratogenic potential than steroids that are less potent.There are no adequate and well-controlled studies of the teratogenic effects of clobetasol propionate in pregnant women. Temovate Cream and Ointment should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus."

    Forms

    Clobetasol propionate is marketed and sold worldwide under numerous names including Clobex, Clob-x (Colombia), Clovate, Clobet (Biolab Thailand) Clonovate (T.O. Chemicals, Thailand), Cormax (Watson, US), Haloderm (Switzerland, by ELKO Org), Pentasol (Colombia), Cosvate, Clop (Cadila Healthcare, India), Propysalic (India), Clobex (South Africa), Temovate (US), Dermovate (GlaxoSmithKline, Canada, Estonia, Pakistan, Portugal, Romania , Israel), Olux, ClobaDerm, Tenovate, Dermatovate, Butavate, Movate, Novate, Salac (Argentina), and Powercort, Lotasbat and Kloderma (Indonesia), Lemonvate (Italy).

    References
    1. "Clobetasol Propionate Topical Ointment 0.05% Information – Drug Encyclopedia". Kaiser Permanente.
    2. "Clobetasol Propionate Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 13 April 2019.
    3. British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 1210. ISBN 9780857113382.
    4. "Clobetasol topical Use During Pregnancy". Drugs.com. Retrieved 13 April 2019.
    5. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 487. ISBN 9783527607495.
    6. "NADAC as of 2019-02-27". Centers for Medicare and Medicaid Services. Retrieved 3 March 2019.
    7. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
    8. Hull, C; McKeough, M; Sebastian, K; Kriesel, J; Spruance, S (2009). "Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: A patient-initiated, double-blind, placebo-controlled pilot trial". Journal of the European Academy of Dermatology and Venereology. 23 (3): 263–267. doi:10.1111/j.1468-3083.2008.03047.x. PMID 19143902.
    9. E. Fougera and Co. "CLOBETASOL PROPIONATE CREAM USP, 0.05% CLOBETASOL PROPIONATE OINTMENT USP, 0.05%<". NIH Daily Med.
    10. Creams Offering Lighter Skin May Bring Risks By CATHERINE SAINT LOUIS, New York Times, JAN. 15, 2010
    11. Gbetoh MH, Amyot M. (1 July 2016). "Mercury, hydroquinone and clobetasol propionate in skin lightening products in West Africa and Canada". Environ. Res. 150: 403–10. doi:10.1016/j.envres.2016.06.030. hdl:1866/19006. PMID 27372064.CS1 maint: uses authors parameter (link)
    12. Office of Environmental Health Hazard Assessment. "Chemicals Under Consideration For Possible Listing Via The "Formally Required To Be Labeled Or Identified" Mechanism". California Environmental Protection Agency. Archived from the original on 2001-07-20. Retrieved 2007-05-06.
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