Clobetasol Propionate

Clobetasol propionate 0.05% (Dermovate in the UK) is the strongest class of Topical Corticosteroids. It is “very potent” on the UK four-tier scale, up to about 600 times as strong as Hydrocortisone (DermNet), and group I “ultra-high” on the US seven-group scale (AFP 2009). In the UK it is a prescription-only medicine. In adults and older children it is used for short courses on thick, stubborn eczema, psoriasis and hands or feet. It has no routine place in toddler eczema care. Its name is close to Clobetasone Butyrate (Eumovate), which is only moderate potency, and the two are easily confused.

Clobetasol Propionate [part-of] Topical Corticosteroids Clobetasol Propionate [relates] Clobetasone Butyrate Clobetasol Propionate [relates] Hydrocortisone

Why not for toddlers without a specialist. NICE CG57 says “do not use very potent preparations in children without specialist dermatological advice”. It also says not to use even potent steroids in children under 12 months without specialist supervision. The MHRA says steroid creams like this should not be used on children under 1 year. A paediatric case series judged clobetasol not recommended under 12 years (Razzaghy Azar 2015). The reasons are physical. Toddlers have a large skin surface area for their weight. Their eczema is often on thin skin (face, folds, nappy area). A nappy works like an occlusive dressing that increases absorption (Nappy Rash). Most paediatric case reports of HPA Axis Suppression involved clobetasol used for months on nappy-area eczema (Mooney 2015). DermNet notes that systemic effects in adults usually need very large amounts (over 50 g of clobetasol a week). A small child absorbs far more per gram. Local risks include Skin Atrophy, which reversed quickly in experimental clobetasol atrophy once stopped (Mooney 2015). The MHRA’s 2021 warning on Topical Steroid Withdrawal names clobetasol as its example of a very potent steroid, with the risk greatest after long continuous use of potent agents.

NICE CG57 [regulates] Clobetasol Propionate Clobetasol Propionate [causes] HPA Axis Suppression Clobetasol Propionate [causes] Skin Atrophy Clobetasol Propionate [causes] Iatrogenic Cushing Syndrome

Documented harm in infants. Razzaghy Azar et al. (J Compr Pediatr 2015) described three children and one adult with Iatrogenic Cushing Syndrome and adrenal insufficiency after long unsupervised clobetasol use. An 11-month-old boy had clobetasol 0.05% applied 6–7 times a day for months for nappy rash. He developed a moon face, blood pressure of 170/100 and height 4 SD below average, with suppressed cortisol and ACTH. In two children the high blood pressure persisted after stopping. One child had kidney failure, hypertensive encephalopathy and permanent loss of vision.

Nappy Rash [relates] Clobetasol Propionate

Hidden clobetasol in "natural" creams

“Herbal”, “Chinese” or “steroid-free” eczema creams have repeatedly been found to contain undeclared clobetasol propionate. A cream that clears a toddler’s eczema unusually fast, with no MA/PL/THR licence number, should be stopped and shown to a doctor. If it has been used heavily for weeks, do not stop abruptly without medical advice (adrenal suppression risk).

Its role in adulterated “herbal” creams. Clobetasol is the hidden steroid found most often in Adulterated Herbal Creams. At Birmingham Children’s Hospital, Ramsay et al. (Arch Dis Child 2003) tested 24 “herbal” creams from 19 children (median age 3.8 years). 20 contained steroids. All the Wau Wa (5) and Muijiza (2) creams contained clobetasol propionate, and Wau Wa was roughly 20% Dermovate in a paraffin base. No parent knew. Many had bought the creams (often over £25) because they feared prescribed steroids (Steroid Phobia). Wau Wa’s label said to apply it “all over”, which would mean about 135 g a week for an average 4-year-old. In 2018 the MHRA found clobetasol plus two antifungals in Yiganerjing Cream, sold as a “natural” Chinese Herbal Medicine, and in Penny Orange Cream from a herbal clinic. In December 2018 it found the same in Zudaifu cream. Its advice was to stop using them, “particularly on young children and babies”, and to check for a licence number (Traditional Herbal Registration). Selling potent steroid creams direct to the public is illegal in the UK.

Adulterated Herbal Creams [relates] Clobetasol Propionate MHRA [opposes] Adulterated Herbal Creams Steroid Phobia [causes] Adulterated Herbal Creams

What parents report (evidence: anecdotal). Parents of toddlers rarely name clobetasol. Potent-steroid stories in round-10 threads involve betamethasone on a 2.5-year-old’s hands and feet after triamcinolone “stopped working”, followed by worry over pale patches (r/eczema), and dermatologists stepping up from hydrocortisone to fluocinolone or fluticasone (r/ScienceBasedParenting; r/toddlers). See Parent Experiences.

Clobetasol Propionate [relates] Parent Experiences

Connections

• Adulterated Herbal Creams — most common hidden steroid, source: Ramsay ADC 2003; MHRA 2018
• MHRA — identified in Yiganerjing/Zudaifu testing, source: MHRA 2018
• HPA Axis Suppression — superpotent agent in most of 25 paediatric case reports (nappy eczema), source: Mooney 2015
• Clobetasone Butyrate — near-identical name but moderate potency; easily confused, source: DermNet
• Topical Corticosteroids — very potent / US group I, source: DermNet; AFP 2009
• NICE CG57 — very potent TCS not in children without specialist advice, source: NICE CG57
• Iatrogenic Cushing Syndrome — infant cases after unsupervised use, source: Razzaghy Azar 2015
• Skin Atrophy — causes; experimental atrophy reversible, source: Mooney 2015
• Nappy Rash — occlusion raises absorption; most infant HPA cases, source: Mooney 2015
• Steroid Phobia — parents bought adulterated creams to avoid steroids, source: Ramsay 2003 press release
• Topical Steroid Withdrawal — MHRA example of very potent TCS, source: MHRA DSU 2021
• Chinese Herbal Medicine — Yiganerjing/Zudaifu sold as Chinese herbal, source: MHRA 2018
• Parent Experiences — parent reports (anecdotal), source: round-10 forum threads