Clobetasol propionate for psoriasis: are ointments really more potent?
Journal of Drugs in Dermatology, June, 2006 by Lindsey Warino, Rajesh Balkrishnan, Steven R. Feldman
Abstract
Background: Clobetasol propionate is the most common topical therapy used for psoriasis in the US. Conventional dermatologic wisdom is that ointment preparations provide the highest potency (due to their occlusive nature and moisturizing ability) and are best suited for psoriasis. However, patients often find application of ointment to be messy, raising concerns about both short-term and long-term adherence to treatment. This article reviews the current literature and assesses the relative potency of clobetasol propionate ointment compared to other clobetasol propionate preparations in the treatment of psoriasis. Relevant literature was identified by PubMed and Google searches. We included studies of psoriasis that reported the percentage of subjects that achieved desired efficacy endpoints, as well as studies that reported the subjects’ mean change in symptoms from baseline. We excluded studies conducted before 1980 and those that allowed concomitant treatments.
Observations: Efficacy rates ranged from 17% to 80% for the different vehicles: ointment, solution, foam, cream, lotion, shampoo, and emollient.
Conclusions: Clobetasol propionate is a very effective treatment for psoriasis. Ointment preparations have similar efficacy to other preparations in clinical trial situations. In clinical practice, a situation in which patient preferences are more likely to affect compliance, it may be best to choose whichever vehicle patients find preferable.
Introduction
Psoriasis is a lifelong disease characterized by emotionally and physically devastating exacerbations and remissions. Topical corticosteroids are used frequently as treatment for psoriasis to decrease inflammation and manage itching. (1) Patients find many topical agents messy and time-consuming to apply. The need for long-term application may be a daunting task for many patients. Poor adherence to treatment over time, due to an undesirable vehicle, may result in poor treatment outcomes.
Ointments are commonly prescribed for psoriasis, in part because of the perception that they are more potent and in part because of the perception that moisturizing psoriasis plaques is inherently beneficial. (2) Nevertheless, ointment-based vehicles are among the least appealing to patients due to their messiness and greasy feel. Bothersome aspects of the vehicle likely reduce patients’ adherence to treatment. (3)
The purpose of this study is to review the literature in order to test the conventional wisdom that ointment vehicles are better for psoriasis by comparing the published potencies of clobetasol propionate in different vehicles.
Methods
Double-blind, randomized, controlled psoriasis studies determining the efficacy of clobetasol propionate (in the forms of ointment, cream, lotion, solution, foam, shampoo, and emollient) were searched for using PubMed and Google. PubMed search terms consisted of “clobetasol propionate” and “psoriasis.” Google search terms consisted of “clobetasol propionate (CP) 0.05%” in conjunction with either “ointment,” “solution,” “shampoo,” “foam,” “lotion,” “cream,” or “emollient.” The Google search was advanced to include only sites that reported the phrase in that exact order.
We included studies that measured efficacy by the percentage of subjects whose symptoms met a desired outcome such as “clear/almost clear” after at least 2 weeks of clobetasol propionate treatment
healing psoriasis the natural alternative
Leave a Comment