What is the standard Sig (prescription instruction) for clobetasol (corticosteroid) 0.05%?

Standard Sig for Clobetasol Propionate 0.05%

Apply a thin layer to affected area(s) once daily for up to 2-4 weeks maximum, then taper frequency as condition improves.

General Dosing Instructions

The standard prescription instruction depends on the specific condition being treated, but the fundamental principle is that ultrapotent corticosteroids like clobetasol propionate 0.05% only require once-daily application based on pharmacodynamic studies 1, 2.

Standard Application Protocol

• Apply once daily (typically at bedtime) to affected areas 1, 2
• Duration: Maximum 2 weeks for most dermatoses without specialist supervision 2, 3
• Quantity: Use thin layer only - a 30g tube should last at least 12 weeks for maintenance conditions 1
• Wash hands after application to avoid inadvertent spread to sensitive areas like eyes 2

Condition-Specific Sig Recommendations

For Lichen Sclerosus (Most Common Long-term Use)

Apply once daily at night for 4 weeks, then every other night for 4 weeks, then twice weekly for 4 weeks 1, 2. This represents the most validated long-term regimen, with approximately 60% of patients achieving complete symptom remission 1, 2. Patients requiring ongoing maintenance typically use 30-60g annually 1, 2.

For Bullous Pemphigoid

• Localized disease: Apply 10g daily to lesional skin only 1, 2
• Mild disease: Apply 20g daily (10g if weight <45kg) 1, 2
• Extensive disease: Apply 30g daily 1, 2
• Reduce dose 15 days after achieving disease control 1

For Psoriasis (Scalp and Body)

Apply twice daily for 2 weeks maximum 3, 4. The foam formulation has shown 74% of patients clear or almost clear after 2 weeks of twice-daily application 3. For non-scalp plaque psoriasis, 68% achieved clear or minimal residual disease with twice-daily application for 2 weeks 4.

For Cutaneous Lichen Planus

Apply 10-20g daily for up to 16 weeks in extensive disease 5. A recent study showed 72% complete remission at 16 weeks with median daily dose of 20g, though this represents higher doses than typically recommended and should be reserved for specialist management 5.

Critical Safety Limitations

Maximum Duration Warnings

• Standard limit: 2 weeks for most conditions without specialist oversight 2, 3
• Extended use beyond 4 weeks significantly increases risk of cutaneous side effects and systemic absorption 2
• Use beyond 12 weeks may be considered only in specific cases (like lichen sclerosus) under specialist care 2

High-Risk Application Sites

• Face, intertriginous areas, and chronically treated areas (especially forearms) carry greatest risk for adverse effects including skin atrophy, striae, telangiectasia, and purpura 2
• Avoid application to open wounds, infected skin, or areas of skin cancer due to increased systemic absorption and impaired healing 6

Systemic Absorption Risk

Application of 7g daily for 2 weeks caused reversible HPA axis suppression in 23% of patients (3/13) in one study 3. This risk increases with:

• Larger surface area coverage 2
• Occlusive dressings 2
• Prolonged duration 2
• Application to damaged skin barrier 6

Practical Sig Examples

For typical inflammatory dermatosis: "Apply thin layer to affected areas once daily at bedtime for 2 weeks. Do not use on face or skin folds. Wash hands after application."

For lichen sclerosus: "Apply once daily at night for 4 weeks, then every other night for 4 weeks, then twice weekly for 4 weeks. Return for follow-up."

For scalp psoriasis: "Apply to affected scalp areas twice daily for 2 weeks maximum. Discontinue after 2 weeks."