American Journal of Clinical Dermatology

, Volume 10, Issue 6, pp 397–406 | Cite as

Topical Clobetasol Propionate in the Treatment of Psoriasis

A Review of Newer Formulations
  • Steven R. Feldman
  • Brad A. Yentzer
Review Article


Ultrapotent topical corticosteroids are the mainstay of psoriasis treatment, used either alone or in combination with a topical vitamin D analog. Traditionally used in an ointment vehicle for psoriasis, clobetasol propionate 0.05% is also available in spray, foam, lotion, and shampoo formulations, which may provide for improved convenience and acceptance in many patients with similar efficacy, safety, and tolerability as the traditional ointment and cream formulations. To compare newer formulations with traditional ointment and cream formulations, we performed a systematic review of the literature. Search terms included ‘clobetasol propionate,’ in combination with ‘psoriasis,’ ‘vasoconstriction,’ ‘vasoconstrictor,’ or ‘absorption’ for each of the four vehicles (‘spray,’ ‘foam,’ ‘lotion,’ and ‘shampoo’).

While there are very few direct comparison studies between clobetasol propionate in different vehicles, the efficacy rates (with success defined as clear or almost clear of psoriasis) for more recent formulations are high, with most patients achieving success after 2–4 weeks of treatment in well controlled clinical trials, with response rates that are similar to those with the traditional clobetasol propionate ointment. Small differences in vasoconstrictor potency or cutaneous absorption have been noted among the formulations, but the clinical significance of these observations is difficult to discern. Recent research has emphasized the importance of treatment adherence in the management of psoriasis. Adherence to treatment is likely to be a far more important determinant of success than are small differences in drug delivery, especially in actual clinical use as opposed to the well controlled environment of clinical trials. For patients who prefer a less messy vehicle, adherence and outcomes are likely to be better with the more recent formulations compared with the traditionally recommended ointment.


  1. 1.
    Pearce DJ, Spencer L, Hu J, et al. Class I topical corticosteroid use by psoriasis patients in an academic practice. J Dermatolog Treat 2004; 15: 235–8PubMedCrossRefGoogle Scholar
  2. 2.
    Gordon ML. The role of clobetasol propionate emollient 0.05% in the treatment of patients with dry, scaly, corticosteroid-responsive dermatoses. Clin Ther 1998; 20: 26–39PubMedCrossRefGoogle Scholar
  3. 3.
    Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroidsparing therapy. J Am Acad Dermatol 2005; 53 (1 Suppl. 1): S50–8CrossRefGoogle Scholar
  4. 4.
    Warino L, Balkrishnan R, Feldman SR. Clobetasol propionate for psoriasis: are ointments really more potent? J Drugs Dermatol 2006; 5: 527–32PubMedGoogle Scholar
  5. 5.
    Housman TS, Mellen BG, Rapp SR, et al. Patients with psoriasis prefer solution and foam vehicles: a quantitative assessment of vehicle preference. Cutis 2002; 70: 327–32PubMedGoogle Scholar
  6. 6.
    Ali SM, Brodell RT, Balkrishnan R, et al. Poor adherence to treatments: a fundamental principle of dermatology. Arch Dermatol 2007; 143: 912–5PubMedCrossRefGoogle Scholar
  7. 7.
    Richards HL, Fortune DG, O’Sullivan TM, et al. Patients with psoriasis and their compliance with medication. J Am Acad Dermatol 1999; 41: 581–3PubMedGoogle Scholar
  8. 8.
    Storm A, Benfeldt E, Ejdrup Anderson S, et al. A prospective study of patient adherence to topical treatments: 95% of patients underdose. J Am Acad Dermatol 2008; 59: 975–98PubMedCrossRefGoogle Scholar
  9. 9.
    Franz TJ, Parsell DA, Myers JA, et al. Clobetasol propionate foam 0.05%: a novel vehicle with enhanced delivery. Int J Dermatol 2000; 39: 535–8PubMedCrossRefGoogle Scholar
  10. 10.
    Franz TJ, Lehman PA, Feldman SR, et al. Bioavailability of clobetasol propionate in different vehicles. Skin Pharmacol Appl Skin Physiol 2003; 16: 212–6PubMedGoogle Scholar
  11. 11.
    Huang X, Tanojo H, Lenn J, et al. A novel foam vehicle for delivery of topical corticosteroids. J Am Acad Dermatol 2005; 53: S26–38CrossRefGoogle Scholar
  12. 12.
    Beutner K, Chakrabarty A, Lemke S, et al. An intra-individual randomized safety and efficacy comparison of clobetasol propionate 0.05% spray and its vehicle in the treatment of plaque psoriasis. J Drugs Dermatol 2006; 5: 357–60PubMedGoogle Scholar
  13. 13.
    Jarratt MT, Clark SD, Savin RC, et al. Evaluation of the efficacy and safety of clobetasol propionate spray in the treatment of plaque-type psoriasis. Cutis 2006; 78: 348–54PubMedGoogle Scholar
  14. 14.
    Lebwohl M, Sherer D, Washenik K, et al. A randomized, double-blind, placebo-controlled study of clobetasol propionate 0.05% foam in the treatment of nonscalp psoriasis. Int J Dermatol 2002; 41: 269–74PubMedCrossRefGoogle Scholar
  15. 15.
    Gottlieb AB, Ford RO, Spellman MC. The efficacy and tolerability of clobetasol propionate foam 0.05% in the treatment ofmild to moderate plaque-type psoriasis of nonscalp regions. J Cutan Med Surg 2003; 7: 185–92PubMedCrossRefGoogle Scholar
  16. 16.
    Reygagne P, Mrowietz U, Decroix J, et al. Clobetasol propionate shampoo 0.05% and calcipotriol solution 0.005%: a randomized comparison of efficacy and safety in subjects with scalp psoriasis. J Dermatolog Treat 2005; 16: 31–6PubMedCrossRefGoogle Scholar
  17. 17.
    Jarratt M, Breneman D, Gottlieb AB, et al. Clobetasol propionate shampoo 0.05%: a new option to treat patients with moderate to severe scalp psoriasis. J Drugs Dermatol 2004; 3: 367–73PubMedGoogle Scholar
  18. 18.
    Hillström L, Pettersson L, Svensson L. Comparison of betamethasone dipropionate lotion with salicylic acid (Diprosalic) and clobetasol propionate lotion (Dermovate) in the treatment of psoriasis of the scalp. J Int Med Res 1982; 10: 419–22PubMedGoogle Scholar
  19. 19.
    Decroix J, Pres H, Tsankov N, et al. Clobetasol propionate lotion in the treatment of moderate to severe plaque-type psoriasis. Cutis 2004; 74: 201–6PubMedGoogle Scholar
  20. 20.
    Lowe N, Feldman SR, Sherer D, et al. Clobetasol propionate lotion, an efficient and safe alternative to clobetasol propionate emollient cream in subjects with moderate to severe plaque-type psoriasis. J Dermatolog Treat 2005; 16: 158–64PubMedCrossRefGoogle Scholar
  21. 21.
    Koo J, Blum RR, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: short- and long-term outcomes. J Am Acad Dermatol 2006; 55: 637–41PubMedCrossRefGoogle Scholar
  22. 22.
    Bergstrom KG, Arambula K, Kimball AB. Medication formulation affects quality of life: a randomized single-blind study of clobetasol propionate foam 0.05% compared with a combined program of clobetasol cream 0.05% and solution 0.05% for the treatment of psoriasis. Cutis 2003; 72: 407–11PubMedGoogle Scholar
  23. 23.
    Smith K. Skin Cap: what have we learned, and when did we learn it? Dermatol Online J 1997; 3: 11cGoogle Scholar
  24. 24.
    Pittelkow MR, Benson LM, Naylor S, et al. Detection of corticosteroid in an over-the-counter product. JAMA 1998; 280: 327–8PubMedCrossRefGoogle Scholar
  25. 25.
    Swanson DL, Pittelkow MR, Benson LM, et al. Déjàvu all over again: Skin Cap still contains a high-potency glucocorticosteroid. Arch Dermatol 2005; 141: 801–3PubMedCrossRefGoogle Scholar
  26. 26.
    Housman TS, Keil KA, Mellen BG, et al. The use of 0.25% zinc pyrithione spray does not enhance the efficacy of clobetasol propionate 0.05% foam in the treatment of psoriasis. J Am Acad Dermatol 2003; 49: 79–82PubMedCrossRefGoogle Scholar
  27. 27.
    Andres P, Poncet M, Farzaneh S, et al. Short-term safety assessment of clobetasol propionate 0.05% shampoo: hypothalamic-pituitary-adrenal axis suppression, atrophogenicity, and ocular safety in subjects with scalp psoriasis. J Drugs Dermatol 2006; 5: 328–32PubMedGoogle Scholar
  28. 28.
    Griffiths CE, Finlay AY, Fleming CJ, et al. A randomized, investigatormasked clinical evaluation of the efficacy and safety of clobetasol propionate 0.05% shampoo and tar blend 1% shampoo in the treatment of moderate to severe scalp psoriasis. J Dermatolog Treat 2006; 17: 90–5PubMedCrossRefGoogle Scholar
  29. 29.
    Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58: 826–50PubMedCrossRefGoogle Scholar
  30. 30.
    Brown KK, Rehmus WE, Kimball AB. Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis. J Am Acad Dermatol 2006; 55: 607–13PubMedCrossRefGoogle Scholar
  31. 31.
    Feldman SR, Brown KL, Heald P. ‘Coral reef’ psoriasis: a marker of resistance to topical treatment. J Dermatolog Treat 2008; 19: 257–8PubMedCrossRefGoogle Scholar
  32. 32.
    Rowlands CG, Danby FW. Histopathology of psoriasis treated with zinc pyrithione. Am J Dermatopathol 2000; 22: 272–6PubMedCrossRefGoogle Scholar
  33. 33.
    Menter A, Abramovits W, Colón LE, et al. Comparing clobetasol propionate 0.05% spray to calcipotriene 0.005% betamethasone dipropionate 0.064% ointment for the treatment of moderate to severe plaque psoriasis. J Drugs Dermatol 2009; 8: 52–7PubMedGoogle Scholar
  34. 34.
    Feldman SR, Camacho FT, Krejci-Manwaring J, et al. Adherence to topical therapy increases around the time of office visits. J Am Acad Dermatol 2007; 57: 81–3PubMedCrossRefGoogle Scholar
  35. 35.
    Lebwohl M, Colón LE. The evolving role of topical treatments in adjunctive therapy for moderate to severe plaque psoriasis. Cutis 2007; 80 (5 Suppl.): 29–40PubMedGoogle Scholar
  36. 36.
    Menter A. Topical monotherapy with clobetasol propionate spray 0.05% in the COBRA trial. Cutis 2007; 80 (5 Suppl.): 12–9PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Steven R. Feldman
    • 1
  • Brad A. Yentzer
    • 1
  1. 1.Wake Forest University School of MedicineWinston-SalemUSA

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