Indications

Xderm (Clobetasol Propionate) is a very potent topical corticosteroid indicated for adults, the elderly, and children over 1 year of age for dermatoses that haven't responded to less potent steroids. This includes:

• Psoriasis (excluding widespread plaque psoriasis).
• Recalcitrant dermatoses (stubborn skin conditions).
• Lichen planus.
• Discoid lupus erythematosus.
• Other skin conditions that do not respond well to less potent steroids.

Composition

All Xderm 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. It has strong anti-inflammatory, anti-itch, and vasoconstrictive properties. It works by multiple mechanisms to inhibit late-phase allergic reactions, decrease the density and activation of inflammatory cells, and reduce the production of inflammatory chemicals.

Dosage & Administration

• Cream, Ointment: Apply a thin layer to the affected areas twice daily. Treatment should be limited to 2 consecutive weeks, with a maximum weekly dose not exceeding 50 gm. For children, courses should be limited to 5 days and reviewed weekly.
• Spray, Scalp Solution: Apply once or twice daily to the affected scalp areas. The total dose should not exceed 50 ml weekly. Discontinue therapy if no response is noted 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 be limited to 4 consecutive weeks, with a total dosage not exceeding 50 g per week.

Interaction

Drugs that can inhibit CYP3A4 (such as ritonavir and itraconazole) have been shown to inhibit the metabolism of corticosteroids, which can lead to increased systemic exposure.

Contraindications

This medication is contraindicated in:

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

Side Effects

Prolonged or intensive use of large amounts can result in sufficient systemic absorption to cause hypercorticism. Local atrophic changes in the skin such as thinning, stretch marks, and enlarged blood vessels may also occur, especially with occlusive dressings. Rare side effects include pigmentation changes and hypertrichosis (excessive hair growth).

Pregnancy & Lactation

There are limited data on the use of Clobetasol Propionate in pregnant women. It should only be used during pregnancy and lactation if the expected benefit outweighs the possible risks. It is unknown whether the drug is excreted in human milk.

Precautions & Warnings

• Long-term continuous therapy should be avoided, especially in infants and children, as it can cause adrenal suppression.
• Courses should be limited to five days for children or if used on the face, and occlusion should not be used.
• Care is needed when applying near the eyelids to ensure the preparation does not enter the eye, as this may result in glaucoma or cataracts.
• In psoriasis, topical corticosteroids may be hazardous due to the risk of rebound relapses or generalized pustular psoriasis. Careful supervision is important.
• If an infection develops, discontinue the topical steroid and use an appropriate anti-microbial therapy.

Overdose Effects

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

Therapeutic Class

Xderm is classified as an Other Topical corticosteroid.

Storage Conditions

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