Dermatologists widely use topical corticosteroids to manage inflammatory skin conditions. Whilst you have probably heard of hydrocortisone, you may be less familiar with clobetasone. This is a less famous but powerful topical steroid for treating skin and scalp issues. In this article we explore what clobetasone is, how it works and what side effects to watch out for. We also compare clobetasone with other steroids in terms of potency and uses.
What is Clobetasone?
To give its full name, clobetasone butyrate is a moderately potent topical corticosteroid. It can help reduce inflammation and irritation in skin conditions like eczema and psoriasis, as well as insect bites or allergies. Clobetasone works by dampening the skin’s immune response, thereby reducing redness, swelling, itching and discomfort. It usually comes as a cream or ointment, and application is normally once or twice daily to the affected area. In the UK it is a prescription-only medicine available under the brand name Eumovate and in compounded formulations.
The main use of clobetasone is the short-term management of inflammatory skin conditions. This is particularly the case when over-the-counter treatments have failed. Some of the most common uses include:
- Eczema (including atopic and contact dermatitis)
- Psoriasis (mild to moderate)
- Seborrhoeic dermatitis
- Lichen simplex
- Insect bites
- Allergic skin reactions
- Inflammatory scarring hair loss such as central centrifugal cicatricial alopecia
It is particularly useful when a mild corticosteroid like hydrocortisone is not effective enough, but you wish to avoid the side effects of stronger steroids.
Where Can Clobetasone be Used?
Clobetasone can be used on most parts of the body as per your doctor’s directions. However, extra caution is needed when using it on sensitive areas such as the groin or underarms. Sometimes, a doctor might even prescribe clobetasone for use on the face or scalp. The skin on the face is more delicate and easily prone to irritation and dryness. As such, clobetasone cream formulations may be better on the face and sensitive areas. Use on the face is also usually for short periods and ideally not more than once daily. For scalp conditions like eczema or psoriasis, it may be useful too. Alongside cautious use, serum, lotion or foam formulas are usually preferred over creams. This is due to their easier application in hair-bearing areas.
How Does Clobetasone Compare with Other Steroids for Potency?
Topical steroids fall into four classes on the potency scale: mild, moderate, potent and very potent. To put the differences in perspective, the National Eczema Society offers a rough guide. A moderate steroid is around twice as potent as 1% hydrocortisone, a potent one roughly ten times and a very potent one at least fifty times. Clobetasone sits in the middle of this scale. Here is how it compares with other commonly available topical steroids:
- Hydrocortisone (mild): Clobetasone has higher potency than this mild corticosteroid. Hydrocortisone is generally considered the first step in treating mild inflammation or for use on delicate areas like the face.
- Betamethasone (potent): This is a powerful corticosteroid that is stronger than clobetasone. Betamethasone is often prescribed for more extensive or persistent inflammation. Whilst it is more effective than clobetasone for stubborn flare-ups, it carries a higher risk of side effects.
- Clobetasol propionate (very potent): Although clobetasone and clobetasol propionate may sound similar, their potency and side effect profiles are quite different. Clobetasol propionate is significantly stronger than clobetasone. It is mainly used for severe skin disorders such as plaque psoriasis and lichen planus. However, this potency also brings a greater risk of side effects like skin thinning and systemic absorption with long-term use.
This balance of potency and risk makes it a good choice when a mild steroid has not worked. A strong steroid, by contrast, may be excessive or risky. As such, doctors may find it a useful option for sensitive or delicate areas that need something stronger than hydrocortisone.
What are the Risks and Side Effects of Clobetasone?
Despite its potency, it is generally safe and well-tolerated when used correctly under medical supervision. However, like all medicines it carries some risks and side effects, including:
- Allergic reaction
- Burning, stinging or itching at the application site
- Skin thinning (atrophy)
- Stretch marks (striae)
- Perioral dermatitis (a rash around the mouth)
- Worsening of reactive skin conditions like rosacea
- Hypopigmentation (lightening of the skin) and changes in skin texture when misused. This is particularly noticeable in medium to dark skin tones and can be permanent.
- Increased susceptibility to infections
Side effects are more likely when it is used for long periods, on delicate skin or over large areas of the body. Long-term or inappropriate use of moderate to high potency steroids can also trigger Topical Steroid Withdrawal Reactions. This is a rebound flare on stopping that the MHRA has specifically warned about. You can reduce the likelihood of these risks by following your doctor’s instructions carefully. Here are some general safety tips that they may recommend:
- Apply a thin layer to clean, dry skin.
- Use it once or twice daily, exactly as prescribed.
- Do not apply it to broken, infected or rosacea-prone skin.
- Avoid long-term use (usually no more than 7 to 14 days continuously unless your doctor prescribes otherwise).
If you experience any side effects, please seek medical help promptly.
What are the Alternatives to Clobetasone?
If you experience side effects, do not respond well to it or find it unsuitable, your doctor may consider an alternative. There are a number of steroidal and non-steroidal anti-inflammatories, with common topical options including:
- Steroids: This includes hydrocortisone as a milder option if clobetasone was too strong, or betamethasone and clobetasol propionate if it was too mild.
- Tacrolimus and pimecrolimus: These calcineurin inhibitors are steroid-free options for inflammatory skin conditions like eczema. They are especially useful for long-term use or on delicate areas.
- Barrier creams and emollients: These are essential for soothing, hydrating and protecting the skin barrier. They are often used alongside a steroid cream but can be an alternative in mild irritation or for maintenance.
Ultimately, your doctor will select the right treatment for the severity and location of your skin concern. They will also take into account your medical history and any existing medications.
Clobetasone is a highly effective steroid cream for managing moderate skin inflammation. Its moderate potency makes it a useful step up from hydrocortisone without the higher risks associated with stronger steroids like clobetasol propionate. However, it is not without risks, especially if used improperly or for excessive periods. As with any medication, follow your prescription instructions and discuss any side effects, and how to reduce them, with your doctor.
We are passionate about personalised skincare and hair treatments. Our doctors treat a range of skin concerns including acne and scars, hyperpigmentation, melasma and skin ageing. We also provide prescription-strength hair loss treatments. Our online clinic offers safe, effective topical custom treatments using prescription-strength ingredients like tretinoin, hydroquinone, minoxidil, finasteride, dutasteride and clobetasone where appropriate. To start your personalised plan, book a video consultation or use our online consultation form. The journey towards great skin and hair starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
