Observations on the systemic effect of topical clobetasol propionate (Dermovate).

Abstract

SummaryTopical application of clobetasol propionate in a strength of 0 05% in cream or ointment (Dermovate) suppressed the hypothalamic-pituitary-adrenal axis in both normal people and patients with diseased skin. In normal people the 9 am serum cortisol level was suppressed when between 45 and 90 g was applied weekly. Insulin stress test results in patients with diseased skin showed an abnormally small response after long-term application of similar amounts. We conclude that long-term administration should be restricted to less than 50 g a week.Three volunteers applied 90 g clobetasol propionate cream weekly to their limbs (fig 1). In two the serum cortisol was completely suppressed by the eighth day; they then extended application of this amount to the whole body for a further week and suppression persisted. The third volunteer failed to show suppression and had a normal serum cortisol level throughout. In his case the experiment was repeated with identical results. Two further volunteers applied the cream to the whole body from the outset and also showed profound adrenal suppression. Fig 2 shows serial cortisol levels for one of these. The levels of the other rose, despite continued application, when he underwent an episode of stress associated with the delivery of his wife's first child.nmol/l 5001

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