From the Guidelines
Clobetasol propionate shampoo should be used for moderate to severe scalp psoriasis by applying it to a dry scalp once daily for up to 4 weeks, with a recommended application of 1-2 tablespoons per use, left on for 15 minutes before rinsing thoroughly 1.
Usage and Frequency
The usage of clobetasol propionate shampoo is indicated for the treatment of moderate to severe scalp psoriasis. It is essential to apply a thin layer to the affected areas, ensuring the scalp is dry before application. The shampoo should be left on for 15 minutes before rinsing thoroughly. Most patients use about 1-2 tablespoons per application.
Duration and Intermittent Use
The initial treatment period with clobetasol propionate shampoo should not exceed 4 weeks. After this period, it is recommended to use the shampoo intermittently if needed, with breaks between treatment courses to prevent side effects. This approach helps in minimizing the risk of cutaneous side effects and systemic absorption associated with prolonged use of super-potent topical corticosteroids like clobetasol propionate.
Side Effects
Common side effects of clobetasol propionate shampoo include burning, stinging, itching, and dryness at the application site. More serious potential side effects include skin thinning, changes in skin color, increased risk of infection, and rarely, systemic absorption leading to adrenal suppression with prolonged use. It is crucial to follow the prescribed regimen exactly and avoid getting the medication in the eyes or on the face. Washing hands thoroughly after application is also recommended.
Mechanism of Action
Clobetasol is a super-potent (class I) topical corticosteroid that works by reducing inflammation, itching, and scaling by suppressing the immune response in the skin. Its efficacy rates in treating psoriasis can vary from 58% to 92%, as seen in several randomized controlled trials 1.
Important Considerations
If symptoms worsen or do not improve after 4 weeks of treatment with clobetasol propionate shampoo, it is essential to consult a healthcare provider for further evaluation and guidance. The choice of topical corticosteroid, including clobetasol propionate, should be based on the disease severity, disease location, patient preference, and the age of the patient, as outlined in recent guidelines 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Clobetasol propionate topical solution should be applied to the affected scalp areas twice daily, once in the morning and once at night. Clobetasol propionate topical solution is potent; therefore, treatment must be limited to 2 consecutive weeks and amounts greater than 50 mL/week should not be used. INDICATIONS AND USAGE Clobetasol propionate topical solution, USP is indicated for short-term topical treatment of inflammatory and pruritic manifestations of moderate to severe corticosteroid-responsive dermatoses of the scalp. Treatment beyond 2 consecutive weeks is not recommended, and the total dosage should not exceed 50 mL/week because of the potential for the drug to suppress the HPA axis.
The proper usage of clobetasol propionate shampoo for scalp psoriasis is to apply it to the affected areas twice daily, in the morning and at night. The recommended duration of treatment is 2 consecutive weeks, with a maximum weekly dosage of 50 mL. The potential side effects of clobetasol propionate shampoo include suppression of the HPA axis 2 2. Key points to consider when using clobetasol propionate shampoo:
- Apply twice daily
- Limit treatment to 2 consecutive weeks
- Do not exceed 50 mL/week
- Potential for HPA axis suppression
- Not recommended for use in pediatric patients under 12 years of age 2
From the Research
Proper Usage of Clobetasol Propionate Shampoo
- The shampoo should be applied to the scalp, preferably in the evening, and left on for a short period of time (around 15 minutes) before rinsing off 3.
- It is recommended to use the shampoo once daily for 4 weeks for the treatment of moderate to severe scalp psoriasis 4, 5.
Frequency and Duration of Treatment
- For short-term treatment, the shampoo can be used once daily for 4 weeks 4, 5.
- For long-term control of moderate scalp psoriasis, an alternate regimen of using the shampoo twice weekly after an initial 4-week daily treatment period can be effective 6.
- The duration of treatment may vary depending on the severity of the condition and the individual's response to the treatment.
Potential Side Effects
- Common side effects of clobetasol propionate shampoo include burning sensation, skin atrophy, and telangiectasia 4.
- However, studies have shown that the shampoo formulation of clobetasol propionate has a lower risk of side effects such as HPA axis suppression and skin atrophy compared to other formulations like gels 3.
- Long-term use of the shampoo has been shown to be safe and effective without leading to more cases of skin atrophy, telangiectasia, HPA axis suppression, or adverse events compared to vehicle 6.