Skin Atrophy Induced by Initial Continuous Topical Application of Clobetasol Followed by Intermittent Application

Abstract

Background: The most frequent side effect of a long-term topical corticosteroid therapy is skin atrophy. To avoid or to reduce atrophy often an initial continuous application is followed by an intermittent maintenance therapy. Objective: In this study we measured the skin thickness before and after the two-phase application schedule with the superpotent topical steroid clobetasol propionate (CP). For 16 days CP samples were applied twice daily on the test areas of 12 volunteers (phase 1). Then CP was applied to the same skin areas in accordance with the following timing: every 5th day, every 7th day, every 10th day, every 14th day (phase 2). Phase 2 lasted for 45 days. During the entire period of the study the skin thickness was measured regularly by the skin compression and thickness method as described previously. Results: It could be seen that in phase 1 the skin became about 15% thinner. In phase 2 the steroid-induced skin thinning was approximately the same when CP was applied every 5th or 7th day. The skin thickness reached a more or less normal level when CP was applied every 10th day. After the 14th day a completely normal level was found. By measuring the skin thickness every day it was further shown that the skin thinning process lasted for 3 days when CP was applied once only. Conclusion: These results demonstrate that skin thinning must be expected by an intermittent maintenance therapy applied at relatively short intervals. The longer the intervals, the weaker the skin thinning. Moreover, these investigations showed that the skin thinning effect after a single CP application persists for nearly 3 days.

A Comparative Clinical Evaluation of Once Daily Versus Alternate Day Application of Topical Clobetasol Propionate Cream in Psoriasis

“…Therefore, there is need of studies which compare the efficacy of the different topical corticosteroids with the once daily regime versus a less frequent dosing. Several ADRs which are associated with the use of the topical corticosteroids are likely to be ameliorated with their less frequent use [21], especially skin atrophy, which was reduced when the topical steroids were applied at relatively longer intervals [22].…”

Vulvar Lichen Sclerosus

“…A different susceptibility to long-term topical corticosteroid therapy between mucosa and skin could explain the differences in induced atrophy, but further studies are needed. 19 Complete remission was obtained in 54% of cases, with a median follow-up of 4.7 years. Although some patients reached CR only after 6 years, the cumulative incidence curve of CR seems to plateau after this time (Figure 1), possibly indicating a chronic evolution of the disease.…”

The Efficacy and Tolerability of Clobetasol Propionate Foam 0.05% in the Treatment of Mild to Moderate Plaque-type Psoriasis of Nonscalp Regions

“…These include burning, stinging, irritation, pruritus, erythema, folliculitis, cracking and fissuring of the skin at the application site, scalp/ear papules and/or pustules, numbness of the fingers, skin atrophy, tingling or tightening of the scalp, acne, headache, and telangiectasia. 5,[7][8][9][10][11] As with use of other topical corticosteroids, the use of clobetasol to treat psoriasis may be associated with tachyphylaxis, rebound, or pustular flares of psoriasis. 4,12 Clobetasol has not been recommended for use beyond a two-week duration, as systemic and topical adverse events may be more frequent and/or severe.…”