CLOBETASOL PROPIONATE
Formtopical
Apply one fingertip unit (0.5 g) of 0.05% ointment once at night for 4 weeks, then on alternate nights for 4 weeks, then twice weekly for 4 weeks. A 30 g tube should last the whole 12 weeks. - A 12-week reducing course, then twice-weekly or as-needed maintenance; aim for no more than 30-60 g in a year
It does occur in girls before puberty, presenting as itch, soreness, constipation or apparent bleeding that is sometimes mistaken for abuse. The same potent steroid is used, but under specialist supervision - refer rather than starting it.
British Society for the Study of Vulval Disease / British Association of Dermatologists guidance on the management of lichen sclerosus (clobetasol propionate tapering regimen)
Lichen sclerosus is not simply an itch. Left undertreated it scars - the clitoris becomes buried, the labia fuse, the introitus narrows - and it carries a small risk of vulval squamous cell carcinoma. A potent topical steroid prevents that. Using a weak steroid because the site is delicate is the common and damaging mistake.
- A persistent sore, ulcer, lump or thickened area lasting more than about 4 weeks needs urgent referral on a 2-week cancer pathway. Lichen sclerosus carries a small risk of vulval squamous cell carcinoma.
- Review at 3 months and again at 9 months. Aim for 30-60 g of clobetasol a year; needing much more means the diagnosis or the adherence needs rechecking.
- A fingertip unit is the amount squeezed along the last joint of an adult index finger, roughly 0.5 g. Being exact about this is what prevents both undertreatment and steroid thinning.
- Do not keep treating it as thrush. Recurrent vulval itch that does not respond to antifungals is lichen sclerosus until proved otherwise.
- An emollient used as a soap substitute alongside; no soap, bubble bath, wipes or perfumed products on the area.
- It occurs in men as balanitis xerotica obliterans. Phimosis from it needs urology, and circumcision can be curative.
- This is a lifelong condition that relapses. Tell the patient that at the start, or the first flare will be read as failure.
| Egyptian brand | Manufacturer | Indicative price |
|---|---|---|
| CLOBITAT 0.05% TOPICAL CREAM 15 GM | BIORIGINAL INTERNATIONAL GROUP PHARMA EGYPT | 5.50 EGP |
| DERMASOL 0.05% CREAM 20 GM | UP PHARMA | 5.50 EGP |
| DERMASOL 0.05% OINT. 20 GM | UP PHARMA | 5.50 EGP |
| CLEROVATE 0.05% TOPICAL OINT. 25 GM | MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) | 7.50 EGP |
| CLOVACORT 0.05% GEL 20 GM | EUROPEAN EGYPTIAN PHARM. IND. | 9.00 EGP |
| CLEROVATE 0.05% CREAM 25 GM | MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) | 10.25 EGP |
| DERMOVATE 0.05 % OINTMENT 25 GM | GLAXO SMITHKLINE | 44.00 EGP |
| DERMOVATE 0.05% TOP. CREAM 25 GM | GLAXO SMITHKLINE | 44.00 EGP |