From the FDA Drug Label
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. The most effective steroid mentioned for treating plaque psoriasis of the scalp is clobetasol.
- The optimal dose is not explicitly stated, but the total dosage should not exceed 50 mL/week. 1
From the Research
For plaque psoriasis of the scalp, clobetasol propionate 0.05% is the most effective steroid option, and it should be applied to affected areas of the scalp once or twice daily for 2-4 weeks, then reduced to intermittent use (2-3 times weekly) for maintenance. This recommendation is based on the most recent and highest quality study available, which demonstrated the efficacy and safety of clobetasol propionate 0.05% spray in treating moderate-to-severe plaque psoriasis of the scalp 2.
Key Points to Consider
- Clobetasol propionate 0.05% works by reducing inflammation, suppressing immune responses, and decreasing cell proliferation that causes psoriatic plaques.
- For application, part the hair and apply directly to affected areas, massaging gently into the scalp.
- Leave on as directed by the formulation (solutions typically 15-30 minutes before washing, while shampoos require 5-15 minutes of contact time).
- Be aware that prolonged use of high-potency steroids can cause skin thinning, so follow the recommended treatment schedule.
- For extensive or resistant cases, consider alternating with non-steroidal treatments like calcipotriol or seeking medical advice for systemic options if topical treatments are insufficient.
Supporting Evidence
- A systematic review of topical treatments for chronic plaque psoriasis of the scalp found that very potent or potent steroid treatments, such as clobetasol propionate 0.05%, are more effective than vitamin D analogues and similarly tolerated 3.
- A post hoc analysis of two pivotal trials of clobetasol propionate 0.05% spray found that it improved signs and symptoms of plaque psoriasis after 1 week of treatment 4.
- Another study found that a sequential treatment regimen of clobetasol propionate 0.05% spray followed by calcitriol 3 μg/g ointment is efficacious and safe for the management of moderate-to-severe plaque psoriasis 5.
Important Considerations
- The efficacy and safety of clobetasol propionate 0.05% have been demonstrated in several studies, including a randomized controlled trial that found it to be effective and well-tolerated for moderate-to-severe plaque psoriasis of the scalp 2.
- While clobetasol propionate 0.05% is the most effective option, it is essential to follow the recommended treatment schedule to minimize the risk of skin thinning and other adverse effects.