Side effects of clobetasol

Temovate

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 4/10/2019

Temovate (clobetasol propionate) is a topical (for the skin) steroid used to treat the inflammation and itching caused by a number of skin conditions such as allergic reactions, eczema, and psoriasis. Temovate is available in generic form. Common side effects of Temovate include:

  • burning,
  • stinging,
  • itching,
  • dryness,
  • redness, or
  • rash at the application site when first applied to the skin. This should disappear in a few days as your body adjusts to Temovate.

Other side effects of Temovate include:

  • dry or cracking skin,
  • thinning or softening of your skin,
  • skin rash or irritation around your mouth,
  • swollen hair follicles,
  • temporary hair loss,
  • spider veins,
  • changes in color of treated skin,
  • blisters,
  • pimples,
  • acne,
  • crusting of treated skin,
  • extreme/unwanted hair growth,
  • “hair bumps” (folliculitis), or
  • stretch marks.

Temovate Cream or Ointment is applied topically (on the skin) to the affected areas twice daily. Treatment should be limited to 2 consecutive weeks and amounts greater than 50 g/week should not be used. Temovate may interact with corticosteroids taken by mouth or drugs that lower the immune system. Tell your doctor about all medications you are taking. During pregnancy, Temovate should be used only when prescribed. It is not known whether this drug passes into breast milk when applied to the skin. Similar medications pass into breast milk when taken by mouth. Consult your doctor before breastfeeding.

Our Temovate (clobetasol propionate) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Clobetasol Topical

Clobetasol topical comes as a cream, gel, ointment, lotion, foam, and spray for use on the skin and as a foam, spray, solution (liquid), and shampoo to apply to the scalp. Clobetasol cream, gel, ointment, lotion, foam, solution (liquid), and spray are usually applied twice a day. Clobetasol shampoo is usually applied once a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use clobetasol topical exactly as directed. Do not apply more or less of it or apply it more often than prescribed by your doctor. Do not apply it to other areas of your body or use it to treat other skin conditions unless directed to do so by your doctor.

Your skin condition should improve during the first 2 weeks of your treatment. Call your doctor if your symptoms do not improve during this time.

To use clobetasol topical, apply a small amount of cream, ointment, gel, lotion, foam, or spray to cover the affected area of skin with a thin even film and rub it in gently.

To use the foam, spray, or solution (liquid) on your scalp, part your hair, apply a small amount of the medicine on the affected area, and rub it in gently. Protect the area from washing and rubbing until the foam, spray, or solution (liquid) dries.

Before using clobetasol foam the first time, carefully read the written instructions that come with it. Ask your doctor or pharmacist to explain any part you do not understand.

To use the shampoo on your scalp, part your hair, apply a small amount of the medicine on the affected area, and rub it in gently. After 15 minutes, wet your hair, use your fingers to form a lather, and then rinse the shampoo out of your hair and off your body with plenty of water. Do not cover your head with a shower cap, bathing cap, or towel while the shampoo is on your scalp. You may wash your hair as usual after applying and rinsing off clobetasol shampoo.

Clobetasol foam may catch fire. Stay away from open fire, flames, and do not smoke while you are applying clobetasol foam, and for a short time afterward.

This medication is only for use on the skin. Do not let clobetasol topical get into your eyes or mouth and do not swallow it. Avoid use in the genital and rectal areas and in skin creases and armpits unless directed by your doctor.

Do not apply other skin preparations or products on the treated area without talking with your doctor.

Do not wrap or bandage the treated area unless your doctor tells you that you should. Such use may increase side effects.

You should wash your hands after applying clobetasol topical.

INVESTIGATION

Comparison of nail lacquer clobetasol efficacy at 0,05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study

Comparação da eficácia do clobetasol em esmalte 0,05%, 1% e 8% no tratamento da psoríase ungueal: estudo piloto, prospectivo, controlado e randomizado

Robertha Carvalho NakamuraI; Luciana de AbreuII; Bruna Duque-EstradaIII; Carla TamlerIV; Andreia Pizarro LeveroneV

IMaster in Dermatology by the Universidade Federal do Rio de Janeiro (UFRJ); Preceptor and Coordinator of the Centro de Estudos da Unha (C.E.U) of the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA – SCMRJ) – Rio de Janeiro (RJ), Brazil
IIPhysician – Post-graduate in dermatology at the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA – SCMRJ) – Rio de Janeiro (RJ), Brazil
IIIPreceptor at the alopecia outpatients clinic of the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA – SCMRJ) – Rio de Janeiro (RJ), Brazil
IVPreceptor at the psoriasis outpatients clinic of the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA – SCMRJ) – Rio de Janeiro (RJ), Brazil
VPreceptor at the Centro de Estudos da Unha of the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (CEU -IDPRDA -SCMRJ) – Rio de Janeiro (RJ), Brazil

Mailing address

ABSTRACT

BACKGROUND: Nail psoriasis may affect up to 90% of patients with psoriasis in the course of the disease throughout their lives and it is often a therapeutic challenge to dermatologists. Topical treatments described in the literature have demonstrated variable efficacy, and unsatisfactory results have been associated to inefficient penetration of the active ingredient into the nail plate and proximal nail fold. Recently the use of clobetasol on nail lacquer vehicle has been suggested, with satisfactory results and no side effects.
OBJECTIVE: To determine the efficacy and safety of clobetasol in nail lacquer vehicle in three concentrations (0.05%, 1% and 8%) in patients with nail psoriasis.
METHODS: Prospective, controlled, randomized pilot study in fifteen patients with nail bed and/or nail matrix psoriasis in both hands, subdivided into three groups: A(0.05% clobetasol nail lacquer), B(1% clobetasol nail lacquer) and C(8% clobetasol nail lacquer). All groups used clobetasol nail lacquer on the left hand and base coat nail lacquer as control on the right, twice a week for 16 weeks. Clinical evaluation was done by photographic records and the NAPSI score of both treated and control hands, as well as modified NAPSI score of the most affected nail of the treated hand.
RESULTS: Group C showed a statistically relevant clinical response compared to the other groups, reflected in the improvement of clinical parameters, of treated hand NAPSI score, when compared to the control hand, and modified NAPSI score of the most affected nail in the treated hand.
CONCLUSION: The 8% clobetasol nail lacquer was effective and safe, and it can be considered a good option of topical therapy in the treatment of nail psoriasis.

Keywords: Clobetasol; Nails; Products for nails and cuticles; Psoriasis; Therapeutics

RESUMO

FUNDAMENTOS: A psoríase ungueal, de difícil manejo terapêutico, pode afetar até 90% dos portadores de psoríase no transcurso da doença, ao longo de suas vidas. Os tratamentos tópicos descritos na literatura têm eficácia variável, muitas vezes com resultados insatisfatórios causados pela ineficiência da penetração da substância ativa através da placa ungueal e dobra proximal. Recentemente tem sido proposto o uso do clobetasol em veículo esmalte, demonstrando resultados satisfatórios e ausência de efeitos colaterais.
OBJETIVO: Determinar a eficácia e segurança do clobetasol em veículo esmalte em três concentrações (0,05%, 1% e 8%) nos pacientes com psoríase ungueal.
MÉTODOS: Estudo piloto, prospectivo, controlado e randomizado com quinze pacientes portadores de psoríase ungueal em ambas as mãos. Os pacientes foram subdivididos em três grupos: A (esmalte clobetasol 0,05%), B (esmalte de clobetasol 1%) e C (esmalte de clobetasol 8%). Os pacientes usaram esmalte de clobetasol na mão esquerda e esmalte base (sem medicação – controle) na direita, aplicandoos duas vezes por semana, por 16 semanas. Fez-se a avaliação clínica por registros fotográficos e pelos
MÉTODOS: NAPSI da mão tratada e controle e NAPSI modificado da unha mais acometida da mão tratada.
RESULTADOS: O grupo C apresentou de forma estatisticamente significativa a resposta clínica mais relevante, refletida na melhora dos parâmetros clínicos, do NAPSI da mão tratada comparado ao da mão controle e do NAPSI modificado da unha mais acometida da mão tratada.
CONCLUSÕES: Neste estudo piloto, o esmalte de clobetasol a 8% foi eficaz e seguro, mostrando-se uma boa opção de terapêutica tópica no tratamento da psoríase ungueal.

Palavras-chave: Clobetasol; Produtos para unhas e cutículas; Psoríase; Terapêutica; Unhas

INTRODUCTION

Psoriasis is one of the most common skin diseases, with a universal distribution, affecting 1 to 2% of the population. It affects both sexes equally and can develop at any age, with incidence peaks during the second and fifth decades. Many hypothesis have been proposed but the etiology is yet unknown. It is known, however, that there is a polygenic inheritance associated with different histocompatibility antigens, and environmental factors are required for the disease to be expressed.1 Stress and mechanical trauma, causing the Köebner phenomenon, are the most important ones.2

The nail involvement is a frequent symptom in psoriasis and it is estimated that it is present in around 25 to 50% of the patients with the disease. 3 However, some authors suggest a rate of 80 to 90% of nail involvement throughout the course of the disease. 4 Among the clinical manifestations, cupuliform depressions and nail pitting or pits are the most common alterations.4,5,6

The correlation between arthopathic psoriasis and nail psoriasis is well known. Around 70% of the arthropathic patients present with the nail involvement commonly seen in psoriasis, which is usually present at the same time of the arthropathy, but can sometimes precede it.7 In arthropathic psoriasis there is diffuse inflammation in the extensor tendon enthesis of the distal interphalangeal articulation which, via contiguity, can sometimes spread to the point of involving the nail bed and matrix. 8,9

When the nail involvement is the only clinical characteristic of the disease, the incidence seen on the literature is variable, on average up to 5%. In most cases the patients present with other lesions on the body besides the nails. 10 Nail psoriasis can be part of the clinical presentation throughout the course of the disease; it might relate to the severity of the disease or be an isolated manifestation.11,12 Nail abnormalities are more common on the fingernails than on the toenails, and usually more than one nail is involved.

The prevalence of onychomycosis is higher in psoriatic patients. Due to the epidemiologic variation in each region, the prevalence of the fungus species found can be: yeast, dermatophyte filamentous fungus and non dermatophyte filamentous fungus.3,13,14 Therefore, the direct mycological examination and the culture must be done before the start of the treatment with corticosteroids.

Throughout the course of the psoriasis, all nail structures might be involved. In decreasing order of frequency, the alterations are: pitting, onycholysis, chromonychia (“salmon- patch” or “oil” spots), subungual keratosis and splinter hemorrhages. The involvement of the skin around the nail apparatus is common. Nail dystrophy varies according to the site of the involvement, as seen on the chart below. (Table 1)

Acropustulosis is a severe and relapsing variant of nail psoriasis.5,12 Nail psoriasis in childhood is rare and usually seen in the form of trachyonychia. Similarly to psoriatic lesions in other anatomic areas, nail psoriasis evolves in outbreaks, with periods of respite and spontaneous or treatment related remission.

Various therapeutic modalities have been used in the topical treatment of nail psoriasis, like topical corticosteroids, fluorouracil, calcipotriol, cyclosporine and tazarotene. Nonetheless, none of them has been absolutely satisfactory, both from the point of view of therapeutic response and dosing convenience. The corticosteroids and the vitamin D analogues remain the most commonly used topical therapies, with a good therapeutic response.4,7,15,16,17

Class 1 corticosteroids (very high potency) have been used for a long time in vehicles like cream or gel, under occlusion, in specific physical abnormalities of the nail matrix. The triamcinolone acetonide (5mg/ml) applied via intralesional infiltration to the proximal nail fold, aiming at reaching the matrix, has been shown to be effective, but adverse effects have been observed, such as intense pain during application and the possibility of nail matrix atrophy.18

The clobetasol propionate is the topical treatment modality most used in the United States of America for cutaneous psoriasis.19 It is also used in the treatment of nail psoriasis at a concentration of 0,05% in cream or gel vehicle, applied daily to the periungual area, over the matrix. However, the benefits are minimal, as the absorbance in this area is not good. Adverse effects with chronic use include the development of hypochromy, atrophy and telangectasias on the periungual area.20

It is known that drugs incorporated to nail lacquer have a superior transungual penetration in relation to other vehicles, as seen in the treatment of onychomycosis. In 1999, Baran and Tosti showed, for the first time, the use of 8% clobetasol propionate in nail lacquer vehicle in the treatment of 45 patients with nail psoriasis. 21 Regaña et al. also discussed their experience with 10 patients.22

In 2008, Regaña at al. performed a study with 15 patients with nail matrix and bed psoriasis using a combination of 8% clobetasol nail lacquer (during the weekends) and occlusive talcacitol cream on the other days, for a six – month period.23 All patients had good therapeutic response, with clinical improvement directly correlated wih treatment duration, showing the efficacy and safety of the association between clobetasol nail lacquer and vitamin D analogue.

In view of this data, the use of the 17-clobetasol propionate in nail lacquer has been shown to be efficient, although still little studied in the treatment of nail psoriasis. As this medication is not yet available for commercial use, compound formulas must be used.

This study aims at explaining and testing the efficacy and safety of clobetasol propionate in nail lacquer vehicle. Three different concentrations were used (0,05%, 1% and 8%), in psoriatic patients with nail abnormalities, aiming at observing the best response. It is expected that this study might provide better information about this new therapeutic option for typical psoriais nail dystrophies.

PATIENTS AND METHODS

Fifteen patients with nail psoriasis in both hands were selected from the Psoriasis outpatients clinic and the Nail Studies Center – Centro de Estudos da Unha (C.E.U) of the Instituto de Dermatologia Prof. Rubem David Azulay – Santa Casa da Misericórdia do Rio de Janeiro (7 men and 8 women, aged between 26 to 76 years, average of 48,7 years). Average duration of the disease was around six years. The study was approved by the Ethics and Research Committee of the Santa Casa da Misericórdia do Rio de Janeiro.

Inclusion Criteria

Involvement of both hands (“nail” matrix and/or bed with psoriatic dystrophy); 18 years of age or older; absence of topical or systemic treatment and/or phototherapy for nail psoriasis for at least four weeks; signing of the Free and Explained Consent Form and the Image Authorization; negative direct mycological examination and culture for fungus and/or bacteria prior to the commencement of the study.

Exclusion Criteria

Topical or systemic treatment and/or phototherapy for nail psoriasis within the past 4 weeks; nonapproval of the Consent Form and Image Authorization; positive direct mycological exam and culture for fungus and/or bacteria; clinical diagnosis of pustular or erythrodermic psoriasis; severe hepatic or renal insufficiency; pregnant or lactating women.

Assessment or the clinical efficacy

The patients were assessed at the beginning of the treatment and at every 4 weeks, for 16 weeks. The nail abnormalities on the treated hand, left hand (LH), control hand, right hand (RH), and the most involved nail of the LH of each patient were classified according to the “score” NAPSI (Nail psoriasis severity index) – a quantitative assessment of the clinical signs: pitting, subungual keratosis, onycholysis and Beau’s lines.24,25 The modified NAPSI score of the most affected LH nail was also assessed. 26

Subungual keratosis was assessed by a pachymeter. Onycholysis, pitting and Beau’s lines were observed through the progress of the nail plate surface involvement. The analysis was performed after dividing the nail surface into 8 spaces of 12,5%, according to the figure (Figure 1). At each clinical assessment the photographic registration was obtained.

The product Safety (clobetasol nail lacquer) was estimated by means of tolerability (continuation of the proposed treatment) and, clinically, by the observation and report of possible local side effects like burning sensation, pain, itch, atrophy.

The patient satisfaction level was obtained via a questionnaire related to the percentage of improvement achieved at the end of the treatment, under the patient’s point of view: above 50% improvement – excellent treatment; between 20-50 % improvement moderate; below 20% improvement – unsatisfactory.

The study factors were the clinical findings, the efficacy and the therapeutic safety.

Study Design

A pilot, experimental, prospective, controlled and randomized study.

The patients were evaluated at every four weeks until they completed four months of treatment (end of the proposed treatment); as such, the patients were seen at weeks 0, 4, 8, 12 and 16.

The patients received one (1) bottle of clobetasol nail lacquer for application on the LH and another one (1) containing colourless base coat, for use on the RH as a control to the contra lateral hand, and were oriented to apply both nail lacquers twice a week (Mondays and Thursdays), till the end of the follow up period.

The 15 bottles containing clobetasol for use on the LH (five at a concentration of 0,05%, five at a concentration of 1% and five at a concentration of 8%) were distributed randomically into three groups and, in addition, the label with concentrations stayed covered up so that neither the doctor nor the patient could not know the concentration used.

At the end of the treatment the nail lacquers were uncovered and the effectiveness was verified through clinical analysis of the photographic records (on weeks zero and 16) and the comparison of the results from the NAPSI on the treated hand and modified NAPSI of the most involved nail of the treated hand among the groups A (clobetasol nail lacquer 0,05%), B (clobetasol nail lacquer 1%) and C (clobetasol nail lacquer 8%) versus control hand (right hand) before and after treatment.25,26

Statistical Analysis

The tests used were: ANOVA of Kruskal-Wallis, Wilcoxon signed-ranked test and Mann-Whitney test. The statistical analysis was processed using the statistical software SAS® System.

RESULTS

On the initial sample, in a total of 15 patients, the most commonly found clinical signs of nail psoriasis were: pitting, onycholysis, subungual keratosis, salmon spots, hemorrhagic striates and complaints of pain. (Table 2)

The analysis of the modified NAPSI of the most affected LH nail, by total sample and by treatment groups, showed significant improvement of the modified NAPSI on the total group of an average of 7,7 points (p = 0,0001), which corresponds, on average, to 51,5% (p = 0,0001). On the individual groups (A, B and C) this improvement was non-significant at the 5% level. However, it can be said that there is a statistical tendency to improvement and, probably, with a bigger sample and a longer duration, this improvement is significant. In conclusion, the establishment of treatment appears to be worthwhile (Table 3).

When analyzing the Napsi variation 25 of the most involved nail of the LH from the general sample and by groups, we observed a significant improvement of the NAPSI of the most involved nail of the LH on the total group of an average of 1 point (p = 0,030).

On the individual groups this improvement was not significant at the 5% level. However, there is a tendency to improvement and, probably, with a bigger sample and for a longer duration this improvement is significant, particularly for the groups B and C. (Table 4)

Therefore, when comparing tables 3 and 4 statistically, there is the suggestion that, for this sample, the MODIFIED NAPSI26 is more sensitive than the NAPSI.25

The progress of the NAPSI on the control hand (RH) did not show any significant improvement from the start to the end of the treatment on either the total sample or the individual groups (Table 5).

When checking for a significant difference of the absolute delta (points) and the relative delta (%) among the three treatment groups: A (0,05% clobetasol), B (1% clobetasol) and C (8% clobetasol), we observed that there was no significant change, at the 5% level, of the relative deltas (%) of the NAPSI among the three nail lacquer groups. However, we observed that, by the variation of the NAPSI on the treated hand (LH), the group C (LH) showed an improvement of 39% more than that of the A and B groups (Table 6).

Adverse effects like atrophy, hypochromy, periungual telangectasia, local pain and hypersensitivity to the medication, as well as patient satisfaction were also registered. In this study there were no reports of adverse effects.

In terms of the perception (or satisfaction) of improvement by the patients: five reported excellent results, four moderate, three non-satisfactory and three patients did not answer this question.

After the photographic analysis, an important improvement was observed on most patients on the group C (8% clobetasol) (Figures 2, 3 and 4).

DISCUSSION

Many therapeutic modalities have been used in the treatment of nail psoriasis; however, none has been fully satisfactory both from the point of view of efficacy and dosing convenience.

Corticosteroids and vitamin D analogues are still the most quoted topic therapies in the literature, with good therapeutic response.4,15,16,17

The use of clobetasol in nail lacquer, described in the literature, showed effective transungual penetration, reduction of both matrix and nail bed abnormalities, highlighting the absence of side effects observed when it is used as clobetasol cream.21,22,23 It is supposed that a high concentration of clobetasol in nail lacquer vehicle (8%) have a better efficacy than the concentration of clobetasol in cream/gel/ointment usually found on the market (0,05%).

Currently, with the advent of adequate vehicles for transungual penetration and the possibility of therapeutic association with corticosteroids it is fair to say that the management of the psoriatic nail has changed dramatically. According to the literature review and the results from this pilot study it was found that the nail lacquer can still be considered an important vehicle for topical treatment of the psoriatic nail. The nail lacquer is a solution to avoid the adverse effects caused by the use of intralesional corticosteroids or corticosteroids in cream or gel applied to the skin, such as atrophy, hypochromy, telangectasia and bone reabsorption – effects still not reported with the use of this vehicle. Clobetasol in gel or cream applied to the nail fold seems to improve only the nail matrix disorders; however, the clobetasol in nail lacquer vehicle was able to improve the lesions on both the nail matrix and bed.

On the studied population, the treatment with clobetasol nail lacquer at different concentrations (0,05%; 1%; and 8%) applied twice a week for 16 weeks was well tolerated and efficient, since the medication was used continuously and no adverse effects were observed. Besides, most patients rated the results as excellent or moderate.

When comparing the NAPSI score with the modified NAPSI we concluded that the latter is simpler and easier to use than the former, this way facilitating the analysis of the data related to the improvement of the nail psoriasis after the treatment.7,25,26

It is important to report that the statistical analysis of the study suggests that a higher number of studied patients, coupled with a longer duration of the study can present even more significant results of the parameters assessed (NAPSI and modified NAPSI of the most affected nails on the treated hands), with higher efficacy on the groups B and C. Nevertheless, the treatment time of any nail dystrophy depends on the time the nail takes to grow in each individual, thus being a longstanding treatment; since psoriasis is a chronic and relapsing disease, it is understandable that its treatment requires some duration.

The nail involvement in psoriasis is difficult to manage and the response to the proposed treatments is slow. Therefore, although there are a number of therapeutic alternatives with good response to medications used topically, systemically, intralesionally, by radiation, or in combination, there is still a paucity of studies that elucidate standardized therapeutic regimens in relation to the most adequate, efficient, safe and ideal option for the patient. Besides, even if there are studies reporting the use of systemic therapies for the treatment of nail psoriasis, like ciclosporine, retinoids and biologicals with excellent results, these drugs are rarely indicated for clinical cases of isolated nail psoriasis.27,28,29

The indication for systemic treatment in isolated nail psoriasis is not a routine, and there are a few cases that need this type of conduct. Unless the patient does not respond to long term local treatment, has a severe level of involvement, or has the acropustulosis variant, the local treatment is preferred.

CONCLUSION

According to the observations from this pilot study, we concluded that the clobetasol nail lacquer is considered a safe therapeutic option in all the three concentrations tested. However, clinically and statistically, the clobetasol nail lacquer at a concentration of 8% (group C) was more efficient than the other concentrations on the resolution and improvement of the parameters both on the nail matrix and bed. Thus, the 8% clobetasol nail lacquer is an efficient and safe therapeutic option in the treatment of nail psoriasis.

The limitations of this study were the lack of double blind testing and the small number of patients. Taking into consideration these factors and the short study period and follow up time, we suggest that more studies are performed in order to corroborate
these results.

2. Sanchez APG. Imunopatogênese da psoríase. An Bras Dermatol. 2010;85:747-9.

8. Tan AL, Benjamin M, Toumi H, Grainger AJ, Tanner SF, Emery P, et al .The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis – a high-resolution MRI and histological study. Rheumatol. 2007;46:253-6.

9. McGonagle D. Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. J Eur Acad Dermatol Venereol . 2009;23 Suppl 1:9-13.

10. Michael M. Jiaravuthisan, Denis Sasseville, Ronald B. Vender, Francis Murphy and Channy Y. Muhn Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57:1-27.

11. Sociedade Brazileira de Dermatologia. Consenso brasileiro de psoríase 2009. Rio de Janeiro: Sociedade Brazileira de Dermatologia; 2009. 116 p.

14. Sánchez-Regaña ML, Videla S, Villoria J, Domingo H, Macaya A, Ortiz E, et al. Report on the prevalence of fungal involvement in a series of pacients with nail psoriasis. Clin Exp Dermatol. 2007;33:194-5.

15. Rigopoulos D, Ioannides D, Prastitis N, Katsambas A. Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream. Acta Derm Venereol. 2002;82:140.

21. Baran R, Tosti A. Topical Treatment of nail psoriasis with a new corticoid-containing nail lacquer formulation. J Dermatol Treat. 1999;10:201-4.

22. Sánchez Regaña M, Martín Ezquerra G, Umbert Millet P, Llambí Mateos F. Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients. J Eur Acad Dermatol Venereol. 2005;19:573-7.

23. Sánchez Regaña M, Márquez Balbás G, Umbert Millet P. Nail psoriasis: a combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment. J Eur Acad Derm Venereol. 2008;22:963-9.

24. Rich PH, Scher RK. Nail psoriasis severity index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003;49:206-12.

25. Baran RL. A nail psoriasis severity index. Br J Dermatol. 2004;150:568-9.

27. Ojeda R, Sánchez Regaña M, Massana J, Oliete R, Umbert P. Clinical experience with the use of cyclosporin A in psoriasis. Results of a retrospective study. J Dermatol Treat. 2005;16:338-41.

28. Tosti A, Ricotti C, Romanelli P, Cameli N, Piraccini BM. Evaluation of the Efficacy of Acitretin Therapy for Nail Psoriasis. Arch Dermatol . 2009;145:269-71.

29. Rigopoulos D, Gregoriou S, Stratigos A, Larios G, Korfitis C, Papaioannou D, et al. Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open-label study. Br J Dermatol. 2008;159:453-6.

Mailing address:
Robertha Nakamura
Rua Engenheiro Cortes Sigaud ,105 / ap.402 Leblon
22450 150 Rio de Janeiro, RJ – Brazil
E-mail: [email protected]

Received on 03.10.2010
Approved by the Advisory Board and accepted for publication on 16.03.2011
Conflict of Interests: None.
Financial Support: None.

Work performed at the Centro de Estudos da Unha (Nail Studies Center) of the Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro (CEU -IDPRDA -SCMRJ) – Rio de Janeiro (RJ), Brazil.

Generic Name: clobetasol topical (kloe BAY ta sol)
Brand Name: Clobex, Clodan, Impoyz, Olux, Olux-E, Temovate, Tovet

Medically reviewed by Drugs.com on Nov 22, 2019 – Written by Cerner Multum

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What is Temovate?

Clobetasol is a highly potent steroid that helps reduce inflammation in the body.

Temovate (for the skin) is used to treat inflammation and itching caused by plaque psoriasis or skin conditions that respond to steroid medication.

Temovate may also be used for purposes not listed in this medication guide.

Important Information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Temovate if you are allergic to it.

Tell your doctor if you have ever had:

  • any type of skin infection;

  • a skin reaction to any steroid medicine;

  • liver disease; or

  • an adrenal gland disorder.

Steroid medicines can increase the glucose (sugar) levels in your blood or urine. Tell your doctor if you have diabetes.

It is not known whether Temovate will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you apply clobetasol to your chest, avoid areas that may come into contact with the baby’s mouth.

Temovate is not approved for use by anyone younger than 12 years old. Some brands or forms of this medicine are for use only in adults 18 and over.

Children can absorb larger amounts of this medicine through the skin and may be more likely to have side effects.

How should I use Temovate?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Do not take by mouth. Topical medicine is for use only on the skin. Rinse with water if this medicine gets in your eyes or mouth.

Do not use Temovate on broken or infected skin. Also avoid using this medicine in open wounds.

Wash your hands before and after using clobetasol, unless you are using the medicine to treat the skin on your hands.

Apply a thin layer of medicine to the affected skin and rub it in gently. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Do not cover the treated skin area with a bandage or other covering unless your doctor tells you to. Covering treated areas can increase the amount of medicine absorbed through your skin and may cause harmful effects.

If you are treating the diaper area, do not use plastic pants or tight-fitting diapers.

This medicine is for short-term use only (2 weeks, or up to 4 weeks for scalp psoriasis). Follow your doctor’s dosing instructions very carefully.

If you use clobetasol to treat plaque psoriasis, you should stop using the medicine once your skin symptoms are controlled.

Call your doctor if your symptoms do not improve, or if they get worse.

You should not stop using clobetasol suddenly. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep from freezing.

Clobetasol foam is flammable. Do not use near high heat or open flame. Do not smoke until the foam has completely dried on your skin.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

High doses or long-term use of Temovate can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using clobetasol topical?

Avoid applying Temovate to your face, underarms, or groin area.

Do not use this medicine to treat any condition that has not been checked by your doctor.

Avoid using other topical steroid medications on the areas you treat with clobetasol unless your doctor tells you to.

Temovate side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • worsening of your skin condition;

  • redness, warmth, swelling, oozing, or severe irritation of any treated skin;

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • high blood sugar–increased thirst, increased urination, dry mouth, fruity breath odor; or

  • possible signs of absorbing this medicine through your skin–weight gain in your face and shoulders, slow wound healing, skin discoloration, thinning skin, increased body hair, tiredness, mood changes, menstrual changes, sexual changes.

Common side effects may include:

  • burning, itching, swelling, or irritation of treated skin;

  • dry or cracking skin;

  • redness or crusting around your hair follicles;

  • spider veins;

  • stretch marks, thinning skin;

  • rash or hives;

  • acne; or

  • temporary hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Temovate?

Medicine used on the skin is not likely to be affected by other drugs you use. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 10.03.

Related questions

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Medical Disclaimer

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Cormax Ointment

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 1/22/2016

Cormax (clobetasol propionate) Ointment is a synthetic corticosteroid indicated for short-term treatment of inflammatory and pruritic (itching) manifestations. Cormax Ointment should not be used in the treatment of rosacea, perioral dermatitis, acne, or as sole therapy in widespread plaque psoriasis.Cormax is available as a generic named clobetasol propionate. Common side effects of Cormax Ointment include local reactions such as burning sensations, irritation, redness, skin rash, and itching. Other side effects of Cormax Ointment include dry or cracking skin, thinning or softening of your skin, rash or irritation around your mouth, swollen hair follicles, temporary hair loss, spider veins, changes in color of treated skin, blisters, pimples, crusting of treated skin, or stretch marks.

Cormax is available in a single strength of 0.05% in 15 and 45 g tubes of ointment. Cormax Ointment is potent; therefore, treatment must be limited to two consecutive weeks, and amounts greater than 50 g per week should not be used. A thin layer of Cormax Ointment should be applied with gentle rubbing to the affected skin area twice daily, once in the morning and once at night. Occlusive dressings should not be used. No drug interactions have been reported. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are prescribed for a nursing woman. There are no adequate and well-controlled studies of the effects of Cormax Ointment on pregnant women. Cormax Ointment should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, and should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time. Cormax should not be used in pediatric patients under 12 years old.

Our Cormax Ointment Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Clobetasol topical

Medically reviewed by Drugs.com on Nov 22, 2019 – Written by Cerner Multum

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What is clobetasol topical?

Clobetasol is a highly potent steroid that helps reduce inflammation in the body.

Clobetasol topical (for the skin) is used to treat inflammation and itching caused by plaque psoriasis or skin conditions that respond to steroid medication.

Clobetasol topical may also be used for purposes not listed in this medication guide.

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

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Clobetasol

Clobetasol is a topical medicine used to treat eczema, psoriasis, allergies (such as an allergic reaction to poison ivy), and many other skin conditions.

It’s sold under various brand names, including Temovate, Olux, Embeline, Cormax, and Clobex.

Clobetasol is a steroid. It works by preventing the release of certain substances in the body that cause inflammation.

The Food and Drug Administration (FDA) approved this prescription medicine in 1985. It’s manufactured by various pharmaceutical companies.

Clobetasol Warnings

Before using clobetasol, tell your doctor if you have, or have ever had:

  • Diabetes
  • A skin infection
  • Thinning of the skin
  • Acne, perioral dermatitis, rosacea, or any other skin problems
  • Cushing’s syndrome (an adrenal gland disorder)
  • A recent vaccination
  • Measles
  • Tuberculosis (TB)
  • Chickenpox or shingles
  • Circulation problems
  • Immune disorders
  • Intracranial hypertension (increased pressure in the head)
  • Glaucoma or cataracts (eye conditions)
  • Allergies to medicines

Don’t use clobetasol for longer than two consecutive weeks (or four consecutive weeks for some formulations that are used on the scalp), unless your doctor tells you otherwise.

Let your doctor know if your symptoms don’t improve, or if they worsen during your treatment with clobetasol.

If you have diabetes, clobetasol may raise your blood sugar levels. Be sure to monitor your condition carefully.

Using too much clobetasol — or using this medicine for a long period of time — may increase your risk of developing adrenal gland problems.

Tell your doctor right away if you experience any of the following symptoms:

  • Blurred vision
  • Dizziness or fainting
  • Fast or irregular heartbeat
  • Irritability, depression, or anxiety
  • Unusual tiredness or weakness
  • Increased thirst or urination
  • Unusual weight gain (especially in the face)
  • New or worsening high blood pressure
  • Loss of appetite or weight loss
  • Muscle weakness

Steroids may affect growth in some children and teens. Talk to your doctor if this is a concern.

Don’t use this medicine on a child under age 12 without consulting with a doctor.

Tell your healthcare provider you’re using clobetasol before having any type of medical or dental procedure.

Pregnancy and Clobetasol

It’s not known whether clobetasol could harm an unborn baby if used during pregnancy.

Tell your doctor if you’re pregnant or might become pregnant.

It’s also unknown whether this medicine passes into breast milk. Talk to your doctor before using clobetasol while breastfeeding.

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