Indications

Clovate (Clobetasol Propionate) is a very potent topical corticosteroid indicated for use in adults, the elderly, and children over 1 year of age for dermatoses that do not respond to less potent steroids. This includes:

• Psoriasis (excluding widespread plaque psoriasis).
• Recalcitrant dermatoses (difficult to treat skin conditions).
• Lichen planus.
• Discoid lupus erythematosus.
• Other skin conditions which do not respond satisfactorily to less potent steroids.

Composition

All Clovate preparations (Cream, Ointment, Scalp Application, Shampoo, Lotion, and Spray) contain Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Pharmacology

Clobetasol Propionate is a highly potent topical corticosteroid with strong anti-inflammatory, anti-pruritic (anti-itch), and vasoconstrictive (blood vessel narrowing) properties. It works by inhibiting the late-phase allergic reactions, decreasing inflammatory cell activity (mast cells and eosinophils), and reducing the production of cytokines and other inflammatory mediators.

Dosage & Administration

• Cream/Ointment: Apply a thin layer to the affected skin areas twice daily. Treatment should be limited to 2 consecutive weeks, and the maximum weekly dose should not exceed 50 gm. In children, courses should be limited to 5 days and reviewed weekly.
• Spray/Scalp Solution: Apply once or twice daily to the affected scalp areas and rub in. The total dose should not exceed 50 ml weekly. Discontinue use if no response is seen after one week.
• Shampoo: Apply to a dry scalp once daily to the affected areas only. Massage gently, leave for 15 minutes, then lather and rinse. Treatment should not exceed 4 consecutive weeks, with a maximum dose of 50 g per week. Not recommended for children under 18.

Interaction

Co-administration with drugs that inhibit the CYP3A4 enzyme (e.g., ritonavir, itraconazole) can increase the systemic exposure to Clobetasol Propionate.

Contraindications

Clovate is contraindicated in:

• Rosacea, acne vulgaris, and perioral dermatitis.
• Primary cutaneous viral infections (e.g., herpes simplex, chickenpox).
• Hypersensitivity to the preparation.
• Primarily infected skin lesions caused by fungi or bacteria.
• Perianal and genital pruritus.
• Dermatoses in children under one year of age.

Side Effects

Prolonged use can lead to systemic absorption, causing features of hypercorticism. Local atrophic changes such as skin thinning, stretch marks, and dilation of superficial blood vessels can occur, especially with occlusive dressings. Rare side effects include changes in pigmentation, hypertrichosis (excessive hair growth), and worsening of psoriasis symptoms.

Pregnancy & Lactation

Clovate should only be used during pregnancy or lactation if the potential benefit to the mother outweighs the possible risks to the fetus or infant. The drug's excretion in human milk is unknown, so caution should be exercised.

Precautions & Warnings

• Long-term continuous therapy should be avoided, particularly in infants and children, to prevent adrenal suppression.
• When used on the face or in children, courses should be limited to 5 days if possible, and occlusive dressings should not be used.
• Avoid applying near the eyes, as it could lead to glaucoma or cataracts.
• In psoriasis, use with caution and under careful supervision due to the risk of rebound relapses and other complications.
• If an infection develops, discontinue the topical steroid and use an appropriate anti-microbial therapy.

Overdose Effects

Acute overdose is unlikely. However, chronic overuse can lead to hypercortisolism, in which case the topical steroid should be discontinued.

Therapeutic Class

Clovate is classified as an Other Topical corticosteroid.

Storage Conditions

Store below 30°C, protected from light and moisture. Do not freeze. Keep out of the reach of children.