What is Temovate E (clobetasol propionate)?

Temovate E (Clobetasol Propionate)

Temovate E is a super-potent (class I) topical corticosteroid containing 0.05% clobetasol propionate in an emollient formulation, used to treat inflammatory and pruritic manifestations of moderate-to-severe corticosteroid-responsive dermatoses. 1

Formulation and Properties

Temovate E contains clobetasol propionate 0.05% in an emollient base that includes:

• Moisturizers
• Dimethicone
• Humectants 2

The emollient formulation provides additional benefits:

• Helps restore normal skin moisturization
• Soothes discomfort associated with dry skin conditions
• May improve steroid penetration through enhanced epidermal hydration 2

Pharmacological Effects

Clobetasol propionate exerts multiple therapeutic actions:

• Anti-inflammatory effects
• Immunosuppressive properties
• Antimitotic effects that influence cell growth and differentiation
• Inhibition of cytokine production 3

Clinical Applications

Clobetasol propionate is indicated for:

• Bullous pemphigoid (rapid healing of bullous lesions) 4, 5
• Lichen sclerosus 4, 6
• Psoriasis (moderate to severe) 4, 7
• Severe atopic dermatitis flares 6
• Refractory alopecia areata 6

Efficacy

• For bullous pemphigoid: Complete epithelialization achieved within 4-17 days of treatment 5
• For psoriasis: 68% of patients achieved clear or almost clear status within 2 weeks 7
• For lichen sclerosus: Approximately 60% of patients achieve complete remission of symptoms 6

Administration Guidelines

Standard Regimen

• Apply a thin layer to affected areas twice daily
• Maximum treatment duration: 2 weeks for most conditions 1
• Do not exceed 50g per week to avoid systemic effects 8

Specific Regimens

For anogenital lichen sclerosus:

1. Once daily at night for 4 weeks
2. Alternate nights for 4 weeks
3. Twice weekly for maintenance 6

For bullous pemphigoid:

• 30-40g per day in two applications over entire body (except face)
• 20g per day if weight < 45kg
• Taper after disease control: daily (month 1) → every 2 days (month 2) → twice weekly (month 3) → once weekly (month 4) 4

Precautions and Contraindications

• Not for use on face, groin, or axillae
• Not for treatment of rosacea or perioral dermatitis
• Avoid use under occlusion except when specifically indicated
• Not recommended for continuous use beyond 2 weeks 1
• Pediatric patients may be more susceptible to systemic toxicity 1

Adverse Effects

Local Effects

• Skin atrophy
• Telangiectasia (dilated blood vessels)
• Striae (stretch marks)
• Folliculitis (particularly with occlusive therapy) 6, 1

Systemic Effects

• HPA axis suppression (can occur with as little as 2g per day)
• Cushing's syndrome
• Hyperglycemia
• Glucosuria 1
• Adrenal suppression (with >50g weekly application) 8

Monitoring

For patients using large amounts or under occlusion:

• ACTH stimulation test
• Morning plasma cortisol levels
• Urinary free cortisol test 1

Patient Education

Patients should be instructed to:

1. Use medication only as directed by physician
2. Apply only to affected areas
3. Avoid contact with eyes
4. Not bandage or wrap treated areas unless directed
5. Report any signs of local adverse reactions
6. Inform physicians about clobetasol use if surgery is contemplated 1

Clinical Pearls

• A 30g tube should last approximately 12 weeks with proper use 6
• Maintenance therapy of 30-60g annually appears safe without significant steroid damage for chronic conditions 6
• When treating bullous pemphigoid, apply to both normal skin and blisters/erosions 4
• For psoriasis, the foam formulation may improve patient satisfaction and compliance 7