clobetasone butyrate: clinical use

Prescribing considerations

• Confirm a corticosteroid-responsive inflammatory diagnosis; reassess worsening or non-responsive disease for infection, rosacea, allergy or another diagnosis.
• Absorption increases with large treated areas, impaired skin, occlusion, skin folds and thin sites such as the face. Infants and children are more susceptible.
• Avoid ocular exposure and investigate visual disturbance.
• Treat coexisting infection appropriately; spreading infection requires reassessment.
• Consider withdrawal reaction if burning and diffuse redness develop after stopping prolonged use.
• Counsel about paraffin-related fabric flammability.

Contraindications and cautions

• Hypersensitivity to clobetasone butyrate or a formulation excipient.
• Untreated skin infection.
• Rosacea.
• Acne vulgaris.
• Itching without inflammation.

Monitoring

• Clinical response and unexpected worsening.
• Local infection, contact allergy, skin atrophy or pigment change.
• Systemic corticosteroid effects where absorption risk is elevated.
• Growth and weight in children where clinically relevant.
• New visual symptoms.
• Rebound or withdrawal-type symptoms after discontinuation.

Clinical pharmacology

A moderately potent topical glucocorticoid with anti-inflammatory, antipruritic and vasoconstrictive activity. Percutaneous absorption is increased by inflammation, impaired barrier function and occlusion; absorbed corticosteroid is mainly metabolised in the liver.

Formulation and product differences

• Cream is water-miscible and suited to moist or weeping surfaces. It contains cetostearyl alcohol, which may cause local skin reactions, and chlorocresol, which may cause allergic reactions.
• Ointment is paraffin-based, greasier and suited to dry, lichenified or scaly lesions.
• Both formulations contain paraffin and carry a fabric-flammability warning.

Cream

Route: Cutaneous

Strengths: 0.05%