What is the appropriate dosage and administration of clobetasol (clobetasol propionate) for topical treatment?

Clobetasol Propionate Topical Prescription Guidelines

For topical clobetasol propionate 0.05%, prescribe a 30g tube to be applied as a thin layer once daily for 2-4 weeks, followed by a tapering schedule to minimize side effects while maintaining efficacy. 1, 2

Dosing Regimens by Condition

General Inflammatory Dermatoses

• Initial therapy: Apply a thin layer once daily to affected areas
• Duration: Limited to 2 consecutive weeks
• Maximum amount: 50 mL/week (or equivalent for cream/ointment)
• Caution: Not to be used with occlusive dressings 2

Anogenital Lichen Sclerosus

• Initial phase: Once nightly for 4 weeks
• Tapering phase: Alternate nights for 4 weeks
• Maintenance phase: Twice weekly
• Annual usage: Most patients require 30-60g annually 3
• Follow-up: Review after 12 weeks (when initial 30g tube should be finished)

Bullous Pemphigoid

• Localized disease: 10-20g daily applied to lesional skin only
• Mild disease: 20g daily (10g if weight <45kg) applied over entire body except face
• Extensive disease: 30-40g daily
• Relapse treatment: 10g daily for localized relapse, 20g daily for mild relapse, 30g daily for extensive relapse 3

Cutaneous Lichen Planus

• Dosage: Up to 20g/day for extensive disease
• Duration: Up to 16 weeks (72% achieve complete remission by week 16) 4

Application Instructions

1. Wash hands before and after application
2. Apply a thin layer to affected areas only (unless otherwise specified)
3. Rub in gently until the medication disappears
4. Avoid the face, groin, and axillae unless specifically directed
5. Do not use occlusive dressings unless specifically prescribed

Tapering Schedule

1. Initial treatment: Once daily for 2-4 weeks (depending on condition)
2. First taper: Alternate days for 2-4 weeks
3. Second taper: Twice weekly for 2-4 weeks
4. Maintenance: As needed or twice weekly for chronic conditions

Important Precautions

• HPA axis suppression: Can occur with >50g/week or treatment >2 weeks 2
• Local side effects: Skin atrophy, telangiectasia, striae (4% incidence) 1, 5
• Systemic effects: Transient morning plasma cortisol reductions (6% of patients) 5
• Rebound: If symptoms return during tapering, return to previous effective frequency 3
• Pediatric use: Not recommended for patients under 12 years 2

Prescription Example

Rx: Clobetasol propionate 0.05% ointment
Disp: 30g
Sig: Apply a thin layer to affected areas once daily at night for 4 weeks, 
     then every other night for 4 weeks, then twice weekly as needed.
     Do not use for more than 12 consecutive weeks.
     Maximum 50g per week.
Refills: 1

Follow-up Recommendations

• Schedule follow-up at 12 weeks to assess response
• Look for resolution of hyperkeratosis, fissuring, and erosions
• Note that atrophy and color changes may persist despite successful treatment 3
• Consider maintenance therapy for chronic conditions

Clobetasol propionate is the most potent topical corticosteroid available and must be used judiciously to balance efficacy with safety concerns. The prescription should always include clear instructions on proper application technique, tapering schedule, and maximum duration of use.