Usage
This combination medication is primarily prescribed for inflammatory skin conditions, especially those characterized by dryness, scaling, and thickening. It is particularly effective for treating:
- Eczema: A group of conditions causing inflamed, itchy, red, cracked, and rough skin.
- Psoriasis: An autoimmune disease causing rapid skin cell buildup, resulting in red, bumpy patches with white scales.
- Corns and calluses: Thickened areas of skin caused by pressure or friction.
- Other hyperkeratotic skin conditions: Such as ichthyosis and lichen planus.
This drug’s pharmacological classifications include:
- Corticosteroid (Clobetasol): Provides potent anti-inflammatory and antipruritic (anti-itch) effects.
- Keratolytic (Salicylic Acid & Urea): Softens and breaks down keratin, facilitating exfoliation of dead skin cells.
- Humectant (Urea & Lactic Acid): Attracts and retains moisture, hydrating the skin.
Alternate Names
There isn’t a universally recognized alternate name for this specific combination. However, each individual component has synonyms:
- Clobetasol: Clobetasol propionate
- Lactic Acid: No common synonyms.
- Salicylic Acid: No common synonyms.
- Urea: Carbamide
Brand names can vary significantly by region. Examples from India include:
- Clobavin-S
- Dermiedge-MF
- COVATE-MF
- Abronate-NF
How It Works
Pharmacodynamics:
- Clobetasol: Binds to glucocorticoid receptors in skin cells, suppressing the inflammatory response by inhibiting the production of prostaglandins and other inflammatory mediators. This reduces redness, swelling, and itching.
- Salicylic Acid: Increases skin hydration and dissolves the intercellular “cement” holding keratinocytes together. This loosens the stratum corneum, promoting shedding of dead skin cells and softening thickened plaques.
- Urea: Breaks down hydrogen bonds between keratin molecules, increasing water absorption by the stratum corneum and improving skin hydration. It also possesses mild keratolytic properties.
- Lactic Acid: Is a naturally occurring alpha-hydroxy acid (AHA) that exfoliates skin by loosening the bonds between dead skin cells. It also acts as a humectant.
Pharmacokinetics:
- Clobetasol: Topically applied clobetasol has minimal systemic absorption when used as directed. A small amount may be metabolized in the skin and liver, ultimately excreted by the kidneys.
- Salicylic Acid: Percutaneous absorption is relatively low, primarily excreted by the kidneys.
- Urea: Mostly stays within the stratum corneum; minimal systemic absorption when used on intact skin.
- Lactic Acid: Minimally absorbed systemically.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area 1-2 times daily. The exact frequency and duration of therapy should be determined by a physician based on the severity and type of skin condition. Do not exceed 50g/week.
Children:
Use in children under 12 years of age is generally not recommended for this combination product, except under the careful supervision of a physician. For individual components like salicylic acid, age-specific dosing guidelines exist.
Special Cases:
- Elderly Patients: Similar to adults but monitor closely for skin thinning.
- Patients with Renal Impairment: Caution advised; potential for increased systemic absorption of clobetasol.
- Patients with Hepatic Dysfunction: Caution advised; potential for altered clobetasol metabolism.
- Patients with Comorbid Conditions: Individualized assessment is necessary, especially for diabetes (clobetasol can affect blood glucose levels).
Clinical Use Cases
This combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. It is designed for topical treatment of dermatological conditions.
Dosage Adjustments
Dose modifications are based on individual patient factors, severity of the condition, and response to treatment. Patients with renal or hepatic impairment may require lower doses or closer monitoring.
Side Effects
Common Side Effects
- Burning or stinging sensation at the application site
- Itching
- Redness
- Dryness
- Peeling or flaking skin
Rare but Serious Side Effects
- Skin atrophy (thinning)
- Telangiectasia (spider veins)
- Hypopigmentation (skin lightening)
- Hypertrichosis (increased hair growth)
- Allergic contact dermatitis
- Systemic absorption of clobetasol (leading to adrenal suppression in rare cases)
Long-Term Effects
- Skin atrophy
- Striae (stretch marks)
- Telangiectasia
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis)
- Cushing’s syndrome (due to systemic absorption of clobetasol)
Contraindications
- Hypersensitivity to any of the components.
- Active bacterial, viral, or fungal skin infections at the application site.
- Rosacea.
- Acne vulgaris.
- Perioral dermatitis.
Drug Interactions
- Other topical medications, especially those containing AHAs or other keratolytics, can increase irritation or enhance absorption of clobetasol.
- Systemic corticosteroids may increase the risk of adverse effects from clobetasol.
Pregnancy and Breastfeeding
- Pregnancy: Safety not well established. Use only if clearly needed and under close medical supervision.
- Breastfeeding: Safety not well established. Use with caution and avoid applying to areas that may come into contact with the infant.
Drug Profile Summary
- Mechanism of Action: Clobetasol: Anti-inflammatory and antipruritic; Salicylic Acid and Urea: Keratolytic; Lactic Acid and Urea: Humectant.
- Side Effects: Burning, stinging, itching, redness, dryness, peeling. Rarely, skin atrophy, telangiectasia.
- Contraindications: Hypersensitivity, active skin infections, rosacea, acne, perioral dermatitis.
- Drug Interactions: Other topical medications, systemic corticosteroids.
- Pregnancy & Breastfeeding: Use with caution if clearly needed.
- Dosage: Apply thinly 1-2 times daily. Do not exceed 50g/week.
- Monitoring Parameters: Skin condition, signs of local or systemic side effects, blood glucose (in diabetic patients).
Popular Combinations
This specific combination is already a popular formulation. If a secondary bacterial or fungal infection is present, a physician may add an antimicrobial agent.
Precautions
- Avoid contact with eyes and mucous membranes.
- Do not use on broken or infected skin.
- Avoid prolonged use and application to large areas of skin.
- Use with caution in patients with diabetes, as clobetasol can affect blood glucose levels.
- Monitor for signs of skin atrophy or other adverse effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clobetasol + Lactic Acid + Salicylic Acid + Urea?
A: Apply a thin layer to affected areas 1-2 times daily. Maximum 50g/week. Consult a physician for precise duration and adjustment based on individual needs.
Q2: Can I use this combination on my face?
A: Use on the face with extreme caution and only under the close supervision of a dermatologist. The skin on the face is more sensitive and prone to adverse effects like atrophy.
Q3: What should I do if I experience burning or stinging after application?
A: Discontinue use and consult your physician. It might indicate irritation or an allergic reaction.
Q4: Can I use this medication during pregnancy or breastfeeding?
A: Safety is not well established. Consult your physician before use.
Q5: How long can I use this medication continuously?
A: Generally, not more than 2 consecutive weeks. For localized psoriasis, a physician may extend use for up to 2 additional weeks if no improvement after the initial two weeks.
Q6: Is it safe to use this medication with other topical treatments?
A: It can potentially interact with other topical medications. Inform your physician about all other topical products you are using.
Q7: What are the signs of skin atrophy?
A: Skin thinning, fragility, easy bruising, telangiectasia (spider veins), and hypopigmentation.
Q8: Can this medication affect blood glucose levels?
A: Yes, clobetasol can potentially affect blood glucose. Monitor levels carefully, especially if you have diabetes.
Q9: Can I cover the treated area with a bandage?
A: Avoid using occlusive dressings unless specifically directed by a physician, as this can significantly enhance clobetasol absorption and increase the risk of systemic side effects.
Q10: Can I use this on open wounds or cuts?
A: No. Apply only to intact skin. Avoid application on open wounds or cuts.
