Can clobetasol (clobetasol propionate) be used to treat keloids?

Clobetasol Propionate for Keloid Treatment

Clobetasol propionate 0.05% cream under silicone dressing occlusion is an effective treatment for keloids with fewer adverse effects compared to intralesional triamcinolone injections. 1

Efficacy of Clobetasol for Keloids

Clobetasol propionate, an ultrapotent (class I) topical corticosteroid, has demonstrated significant efficacy in treating keloids when used appropriately:

• A randomized, single-blind trial showed that clobetasol propionate 0.05% cream under silicone dressing occlusion was equally effective as intralesional triamcinolone for keloid treatment 1
• The study demonstrated significant improvement in both patient and observer scar assessment scales (POSAS) after 12 weeks of treatment 1
• Keloid dimensions showed similar improvement trends with both clobetasol under occlusion and intralesional triamcinolone 1

Treatment Protocol

For optimal results when treating keloids with clobetasol propionate:

1. Apply a thin layer of clobetasol propionate 0.05% cream to the keloid
2. Cover with silicone dressing (e.g., Mepiform®)
3. Apply daily for 12 weeks 1
4. Monitor for improvement in keloid size, symptoms, and appearance

Advantages Over Intralesional Triamcinolone

Clobetasol propionate under occlusion offers several advantages over traditional intralesional steroid injections:

• Significantly fewer adverse effects, including:
  • Less erythema (17.6% vs 41.2%)
  • Less hypopigmentation (23.5% vs 35.3%)
  • Less telangiectasia (17.6% vs 41.2%)
  • Less skin atrophy (5.9% vs 23.5%) 1
• Pain-free application (compared to 100% of patients reporting pain with injections)
• No necrotic skin reactions (compared to 70.6% with injections)
• Patient-friendly, home-based treatment option
• Particularly beneficial for patients with needle phobia or low pain threshold 1

Mechanism of Action

Clobetasol propionate exerts its therapeutic effects through:

• Anti-inflammatory properties
• Immunosuppressive effects
• Antimitotic effects that influence cell growth and differentiation
• Inhibition of cytokine production 2

Potential Side Effects and Monitoring

Despite its efficacy, clobetasol requires careful monitoring due to its potency:

• Local side effects may include skin atrophy, telangiectasia, and striae 2
• Systemic absorption is possible with prolonged use, potentially causing hypothalamic-pituitary-adrenal axis suppression 2
• Regular follow-up is recommended to assess both efficacy and potential adverse effects

Special Considerations

• Patient education on proper application technique is crucial
• Patients should wash hands after application to avoid spreading medication to sensitive areas
• The silicone dressing component provides additional therapeutic benefit through occlusion and may enhance the efficacy of the treatment 1
• Clobetasol propionate has been successfully used in other dermatological conditions, demonstrating its versatility as a potent topical steroid 3, 4

Clinical Pearls

• Ensure patients understand the proper amount to apply (thin layer only)
• Emphasize the importance of consistent application for optimal results
• Consider a pulsed-dose regimen for maintenance after initial improvement to minimize side effects 3
• The foam formulation may be more cosmetically acceptable for certain body areas 3