From the Guidelines
High potency steroids, such as clobetasol propionate, betamethasone dipropionate, and fluocinonide, are effective treatments for severe skin conditions, including psoriasis and atopic dermatitis, with efficacy rates ranging from 58% to 92% 1. When using high potency steroids, it is essential to consider the potential side effects, such as skin thinning, stretch marks, and increased susceptibility to infections.
- These medications should be applied thinly to affected areas once or twice daily for limited periods, usually 2-4 weeks, to avoid side effects.
- High potency steroids should be used cautiously, especially on thin skin areas like the face, groin, or armpits.
- They should be tapered gradually rather than stopped abruptly, and should only be used under medical supervision. The choice of high potency steroid should be based on the disease severity, disease location, patient preference, and the age of the patient, with lower potency corticosteroids recommended for use on the face, intertriginous areas, and areas susceptible to steroid atrophy 1. For long-term management of chronic conditions, lower potency steroids or steroid-sparing alternatives are often preferred to minimize adverse effects.
- A study of betamethasone dipropionate for 3 weeks demonstrated 94.1% of patients in the treatment group showed either a good or excellent clinical response 1.
- Very high potency TCS, such as clobetasol propionate, fluocinonide, and halobetasol propionate, can be effective for controlling flares, particularly in severe AD, with a change in severity over 2 weeks to clear/almost clear (67.2% vs 22.3% for vehicle) 1.
From the FDA Drug Label
The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. Clobetasol propionate, a corticosteroid, has been shown to have topical (dermatologic) and systemic pharmacologic and metabolic effects characteristic of this class of drugs
- Clobetasol propionate is a high potency topical corticosteroid, as it is effective in the treatment of corticosteroid-responsive dermatoses primarily because of its anti-inflammatory, antipruritic, and vasoconstrictive actions 2
From the Research
High Potency Steroids
- High potency steroids, such as prednisone, are commonly used as immunosuppressive medications in the treatment of various diseases, including atopic dermatitis and graft-versus-host disease 3, 4, 5.
- The use of high potency steroids has been shown to have both beneficial and adverse effects, including the prevention of acute graft-versus-host disease and the increased risk of serious infections 3, 4, 5.
- The choice of immunosuppressive medication, including high potency steroids, depends on the specific disease being treated and the individual patient's needs and medical history 6.
Comparison of Immunosuppressive Medications
- A study comparing the safety of systemic immunomodulatory medications in adults with atopic dermatitis found that cyclosporine and methotrexate had the lowest 6-month risks of serious infections, while prednisone, azathioprine, and mycophenolate showed increased risks compared to methotrexate 3.
- Another study found that the addition of methylprednisolone to a regimen of cyclosporine and methotrexate reduced the incidence of acute graft-versus-host disease in patients undergoing bone marrow transplantation from an HLA-identical sibling donor 5.
Mechanisms and Toxicities
- Immunosuppressive agents, including high potency steroids, have been developed to target specific mechanisms of the immune response, reducing the risk of toxicities associated with earlier agents 6.
- The development of new immunosuppressive medications has improved graft survival in kidney transplantation and provided alternatives to cytotoxic therapy in immune-mediated diseases 6.