Clinical Experience
- Clobetasone Butyrate 0.05% Cream and Ointment (Eumovate®) is a moderately potent topical corticosteroid. Clinical experience shows that moderate strength topical corticosteroids act more quickly than hydrocrtisone and as a result can reduce the total amount of drug that is used.
- Topical corticosteroid efficacy has been repeatedly demonstrated in randomised controlled trials for atopic eczema.
- Eumovate® has been shown to be more effective than hydrocortisone 1.0% for treating atopic eczema, and skin thinning has not been reported with short term use. There was negligible systemic absorption.
- Eumovate® has recently been approved for short term use in adults and children over 12 who have acute eczema and allergic dermatitis directly from their local pharmacist in the UK.
[J Dermatol Treat. 2003 Jun;14(2):71-85.]
General Considerations
- Clobetasone butyrate (Eumovate®) is significantly different from, and should not be confused with clobetasol propionate (Dermovate®), which is classed as a very potent corticosteroid.
- Topical corticosteroids are indicated to provide symptomatic relief of inflammation and/or pruritus associated with acute and chronic corticosteroid-responsive disorders.
- The location of the skin lesion to be treated should be considered in selecting a formulation. Weak to moderate potency products may be used on the ears, trunk, arms, legs and scalp. They should be used on the face and intertriginous areas for a limited duration.
- In dermatological practice, hydrocortisone 1% remains a mainstay for treatment of facial eczema and skin folds, but is often not effective for treating eczema affecting other body areas.
These terms can be used interchangeably when referring to the potency of a topical corticosteroid:
- Weak/Mild = Low
- Moderate = Medium
- Potent = High
- Very Potent = Superpotent
Indications
Indicated for the treatment of:
- Atopic dermatitis (AD)
- Seborrheic dermatitis, and other corticosteroid responsive skin conditions, e.g., lichen planus lichen sclerosis et atrophicus
- Psoriasis
- Vitiligo, which do not require the use of a more potent topical corticosteroid.
[CPS. The Canadian Drug Reference for Health Professionals. Ottawa: Canadian Pharmaceutical Association (2003)]
Atopic Dermatitis
- Moderate potency formulations are often successful in treating flares of atopic dermatitis on the trunk and extremities. Disease control usually occurs after 2-3 weeks of twice daily treatment, followed by the twice daily application of a lower potency corticosteroid to complete the treatment or used for early signs of recurrence.
[Comprehensive Dermatologic Drug Therapy, Wolverton SE, Editor. Philadelphia: W.B. Saunders Company, 2001; pp 548-77.]
- The use of large quantities of emollients can reduce the quantity and potency of topical steroids required to control AD, thus reducing the chance of adverse effects from the topical steroids as well as cost saving.
[Cork, et al. Optimising treatment of atopic dermatitis: the emollient to topical steroid prescribing ratio. Presented at: Derm Update, Montreal, QC 2003.]
Lichen Planus
- Generally responds to topical corticosteroids. Double-blind comparative trials demonstrated that topical corticosteroids were better than other vehicles at treating this disease.
[Archiv fur Dermatologische Forschung. 1975; 251:165-8. Bordeaux Medical. 1972; 5:1091-100.]
Lichen Sclerosis et Atrophicus
- Superpotent formulations applied twice daily for 45 days and then once daily for 45 days successfully improved the subjective and objective components of this disease.
[Minerva Ginecologica. 1997;49:207-12.]
- In children, a regimen of high-potent or superpotent topical corticosteroids followed by maintenance with low-potency topical corticosteroids was found to be safe and effective.
[Aust J Dermatol. 1995; 36:166-7.]
Psoriasis
- Topical corticosteroids are most useful for localized psoriasis or psoriasis of the scalp. Localized plaque psoriasis generally required a high-potency or superpotent formulation twice daily followed by a maintenance regimen to obtain and preserve remission. When used in combination with other therapies such as PUVA, oral etretinate and mometasone, topical corticosteroids can produce more rapid clearing rates.
[Psoriasis. Camisa C, Editor. 1994 Blackwell Scientific Publications, pp 177-96.]
- Clinical experience suggests that using steroids alone for a long duration can make psoriasis more stubborn to treat.
Seborrheic Dermatitis
- Only low-potency topical corticosteroid creams are necessary for control of this condition on the face. If traditional anti-dandruff shampoos fail, moderate-to-high potency corticosteroid lotions or solutions may be used on the scalp.
[Comprehensive Dermatologic Drug Therapy, Wolverton SE, Editor. Philadelphia: W.B. Saunders Company, 2001; pp 548-77.]
