clobetasol

[klo-ba´tah-sol] a synthetic corticosteroid used topically as the salt for the relief of inflammation and pruritus in corticosteroid-responsive dermatoses.

clobetasol

(kloe-bay-ta-sol) clobetasol,

Clobex

(trade name),

Dermovate

(trade name),

Temovate

(trade name),

Temovate E

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Management of inflammation and pruritis associated with various allergic/immunologic skin problems.

Action

Suppresses normal immune response and inflammation.

Therapeutic effects

Suppression of dermatologic inflammation and immune processes.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may increase systemic absorption.Distribution: Remains primarily at site of action.Metabolism and Excretion: Usually metabolized in skin; may be modified to resist local metabolism and have a prolonged local effect.Half-life: Unknown.

Time/action profile (response depends on condition being treated)

ROUTE	ONSET	PEAK	DURATION
Topical	min–hrs	hrs–days	hrs–days

Contraindications/Precautions

Contraindicated in: Hypersensitivity or known intolerance to corticosteroid or components of vehicles (ointment or cream base, preservative, alcohol); Untreated bacterial or viral infections.Use Cautiously in: Hepatic dysfunction; Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition); Patients with pre-existing skin atrophy; Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children (chronic high-dose use may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression); Not recommended for use in children <12 yr.

Adverse Reactions/Side Effects

Dermatologic

allergic contact dermatitis
atrophy
burning
dryness
edema
folliculitis
hypersensitivity reactions
hypertrichosis
hypopigmentation
irritation
maceration
miliaria
perioral dermatitis
secondary infection
striae

Miscellaneous

adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Topical (Adults and Children) Apply to affected area(s) 1–3 times daily (depends on preparation and condition being treated).

Availability (generic available)

Cream: 0.05% Emollient cream: 0.05% Foam: 005% Gel: 0.05% Lotion: 0.05% Ointment: 0.05% Scalp solution: 0.05% Shampoo: 0.05% Spray: 0.05%

Nursing implications

Nursing assessment

Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.
Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
- May cause increased serum and urine glucose concentrations if significant absorption occurs.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments. Solution, spray, and shampoo are useful in hairy areas.
Topical: Apply ointment, creams, gel, or lotion sparingly as a thin film to clean skin. Wash hands immediately after application. Apply occlusive dressing only if specified by health care professional.
- Apply solution and shampoo to hair by parting hair and applying a small amount to affected area. Rub in gently. With solution, protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not right after applying medication. With shampoo, wash hair as usual 15 minutes after application.
- Apply spray sparingly as a thin film to clean, dry skin. Wash hands immediately after application.

Patient/Family Teaching

Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for the next dose.
Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
Caution women that medication should not be used extensively, in large amounts, or for protracted periods if they are pregnant or planning to become pregnant.
Advise patient to consult health care professional before using medicine for condition other than indicated.
Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.

Evaluation/Desired Outcomes

Resolution of skin inflammation, pruritus, or other dermatologic conditions.

clobetasol

A powerful steroid drug used for external application in severe dermatological disorders. Brand names are Dermovate and Eumovate.