What dose of hydrocortisone is equivalent to Clobetasol (Clobetasol propionate) 0.05%?

From the Guidelines

Clobestol 0.05% is equivalent to approximately 600 times the potency of 1% hydrocortisone, making it one of the most potent topical corticosteroids available. This means that a very small amount of clobestol 0.05% produces effects similar to a much larger amount of hydrocortisone. Clobestol propionate belongs to the class I (super-potent) topical corticosteroids, while hydrocortisone is a class VII (lowest potency) agent. Due to this high potency, clobestol should be used sparingly and for limited durations, typically not exceeding two consecutive weeks of treatment. The significant potency difference exists because clobestol has chemical modifications that enhance its binding affinity to glucocorticoid receptors and increase its tissue penetration.

Key Points to Consider

• The potency of clobestol 0.05% is significantly higher than that of hydrocortisone, with a potency ratio of approximately 600:1 1.
• Clobestol propionate is classified as a class I (super-potent) topical corticosteroid, while hydrocortisone is classified as a class VII (lowest potency) agent 1.
• The high potency of clobestol 0.05% increases the risk of side effects such as skin thinning, striae, and hypothalamic-pituitary-adrenal axis suppression, especially when used on large body surface areas or under occlusion 1.
• Patients should be aware of the potential risks and benefits of using clobestol 0.05% and should use it sparingly and for limited durations, typically not exceeding two consecutive weeks of treatment 1.

Clinical Implications

• When prescribing clobestol 0.05%, clinicians should carefully consider the potential risks and benefits and should monitor patients closely for signs of side effects.
• Patients should be educated on the proper use of clobestol 0.05% and should be advised to use it sparingly and for limited durations.
• Alternative treatments, such as hydrocortisone, may be considered for patients who are at risk of side effects or who have not responded to clobestol 0.05%. In terms of equivalent hydrocortisone dose, clobestol 0.05% is equivalent to approximately 15-20 mg of hydrocortisone 1, which is a commonly used dose for replacement therapy in patients with adrenal insufficiency. However, it's essential to note that this equivalence is approximate and may vary depending on individual patient factors and the specific condition being treated.

From the Research

Comparison of Clobestol 0.05% with Hydrocortisone

• Clobetasone butyrate 0.05% is more effective than 1.0% hydrocortisone in the treatment of eczema 2
• A study comparing 0.05% clobetasone butyrate and 0.1% hydrocortisone butyrate in cream bases found that both treatments improved eczematous lesions, but there was no significant difference between the two treatments 3
• The potency of clobetasone butyrate 0.05% is not directly comparable to hydrocortisone 0.05%, but it is more effective than 1.0% hydrocortisone in the treatment of eczema 2
• Hydrocortisone 17-butyrate 21-propionate (hydrocortisone buteprate, HBP) is a medium potent topical corticosteroid with a favorable benefit/risk ratio, and its potency is comparable to that of betamethasone 17-valerate (BV) 4

Equivalent Hydrocortisone Dose

• Based on the available evidence, clobestol 0.05% is similar to hydrocortisone 1% in terms of potency 2
• However, the exact equivalent dose of hydrocortisone for clobestol 0.05% is not explicitly stated in the available studies 2, 3, 4