From the Guidelines
When prescribing Eucrisa (crisaborole), betamethasone lotion, and clobetasol propionate, it is crucial to prioritize the use of clobetasol propionate for severe, extensive disease due to its proven benefit in disease control, adverse events, and mortality, as shown in a study comparing topical clobetasol propionate to oral prednisone 1.
Key Considerations
- Eucrisa (crisaborole) is a non-steroidal topical phosphodiesterase-4 inhibitor suitable for mild to moderate atopic dermatitis, with a low risk of skin atrophy, making it ideal for long-term use and sensitive areas.
- Betamethasone lotion is a medium-potency topical corticosteroid used for inflammatory skin conditions, with a recommended application of a thin layer 1-2 times daily for up to 2 weeks on the body and 1 week on the face.
- Clobetasol propionate is a super-potent topical corticosteroid reserved for severe, resistant dermatoses, with a recommended application of a thin layer twice daily for a maximum of 2 weeks, avoiding the face, groin, and axillae.
Important Safety Information
- All three medications require monitoring for adverse effects, with corticosteroids carrying risks of skin atrophy, telangiectasia, and HPA axis suppression with prolonged use.
- A step-down approach can be considered, starting with a potent steroid like clobetasol propionate for quick control, then transitioning to medium-potency betamethasone lotion, and finally to Eucrisa for maintenance therapy to minimize steroid exposure while maintaining disease control, as supported by the study comparing topical clobetasol propionate to oral prednisone 1.
Disease Severity and Treatment
- For extensive disease (more than 10 new blisters a day), clobetasol propionate has shown significant benefits in disease control, adverse events, and mortality compared to oral prednisone 1.
- In moderate disease (fewer than 10 new blisters a day), no significant differences were found between clobetasol propionate cream and prednisone 0.5 mg kg-1 daily for disease control, adverse events, and mortality 1.
From the FDA Drug Label
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. PRECAUTIONS General Clobetasol propionate is a highly potent topical corticosteroid that has been shown to suppress the HPA axis at doses as low as 2 g (of ointment) per day. 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.
The considerations for prescribing clobetasol propionate include:
- Short-term use: Treatment should be limited to 2 consecutive weeks 2
- Dosage: Apply to affected scalp areas twice daily, with a maximum of 50 mL/week 2
- HPA axis suppression: Monitor patients for signs of HPA axis suppression, especially when using large doses or applying to large surface areas 3
- Pediatric use: Not recommended for use in pediatric patients under 12 years of age 4
- Occlusive dressings: Should not be used with occlusive dressings 2
- Systemic toxicity: Pediatric patients may be more susceptible to systemic toxicity due to proportionally larger absorption of topical corticosteroids 3
- Irritation and infection: Discontinue use if irritation develops, and institute appropriate therapy; if the inflammatory lesion becomes infected, use an appropriate antifungal or antibacterial agent 3 The FDA drug label does not provide information on Eucrisa (crisaborole) and betamethasone lotion.
From the Research
Considerations for Prescribing Eucrisa (Crisaborole)
- Eucrisa (crisaborole) is a novel, anti-inflammatory inhibitor of phosphodiesterase 4 (PDE4) available for the topical treatment of mild to moderate atopic dermatitis in patients aged ≥ 2 years 5, 6, 7, 8
- Crisaborole ointment 2% has been shown to reduce disease severity and pruritus severity compared with vehicle, with a favorable safety profile 5, 6, 7, 8
- The most common side effects of crisaborole are pain and paresthesia at the application site 7
Considerations for Prescribing Betamethasone Lotion
- There is limited information available on betamethasone lotion in the provided studies
- However, it is known that betamethasone is a topical corticosteroid, and its use should be considered with caution due to potential side effects and misuse 9
Considerations for Prescribing Clobetasol Propionate
- Clobetasol propionate is a commonly used topical steroid, but its misuse and overuse can lead to adverse effects such as recurrence or increase in the extent of infection 9
- It is essential to educate patients, pharmacists, and general practitioners about the ethical and rational use of topical steroids, including clobetasol propionate 9
- Clobetasol propionate should be used with caution and under the guidance of a healthcare professional to minimize the risk of adverse effects 9
Comparison and Combination Therapy
- Crisaborole may be considered as an alternative to topical corticosteroids, including betamethasone lotion and clobetasol propionate, due to its favorable safety profile and efficacy in treating mild to moderate atopic dermatitis 5, 6, 7, 8
- The role of crisaborole in combination therapy with other topical treatments, including corticosteroids, is still being studied and may provide additional benefits for patients with atopic dermatitis 7, 8