In moderate to severe plaque-type psoriasis, Clobetasol propionate cream USP, % (emollient) applied to 5% to 10% of body surface area can be used for up to 4 weeks. The total dosage should not exceed 50 grams per week. When dosing for more than 2 weeks, any additional benefits of extending treatment should be weighed against the risk of HPA suppression. Therapy should be discontinued when control has been achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary. Treatment beyond 4 consecutive weeks is not recommended.
Gabriel first started exhibiting small patches of eczema at 10 months old. He was prescribed a “light” steroid cream by the doctor, but the eczema only became worse. The doctor then prescribed Mometasone and Elidel creams. His parents did exactly what they were instructed to do, and they watched Gabriel become more itchy and miserable before their eyes. He was then prescribed, Triamcinolone Acetonide Ointment, Fluocinolone, oral antibiotics, and oral steroids. They were instructed to apply the topical steroids 3 times a day. This therapy worked temporarily, but when it stopped working, Gabriel’s mother described his skin looking as if it were “attacking itself.”
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.