Relative efficacy and interchangeability ofvarious clobetasol propionate vehicles in the management of steroid-responsive dermatoses

Abstract

Background: Topical corticosteroids have long been the cornerstone in thetreatment of steroid-responsive dermatoses. Despite the effectiveness of these formulations, there is a misperception that drugs delivered via ointments are more potent than those delivered via other vehicles. Potency, however, is a complex function of the physical and chemical properties of both the active ingredient and its vehicle. Studies have determined that newer vehicles (eg, lotions), particularly those in the super-high-potency class, not only heighten the ability of the active ingredient to penetrate skin but also are preferred by patients over ointments and creams. Objective: This review of the literature investigates the effectiveness andtolerability of a high-potency corticosteroid lotion compared with cream or emollient cream formulations in treating moderate to severe plaque-type psoriasis and atopic dermatitis. Methods: A literature search was conducted of US and international published clinical trials (1975 to November 2004) comparing all potencies of topical corticosteroid cream and lotion formulations using MEDLINE and the Web sites of individual dermatologic journals. No specific study designs were excluded from this search. Search terms included corticosteroid-responsive dermatoses, creams versus lotions, topical corticosteroid clinical trials, plaque-type psoriasis, atopic dermatitis, clobetasol propionate, drug bioavailability, Class I topical agents, and vasoconstriction. The primary diagnoses were moderate to severe plaque-type psoriasis and atopic dermatitis. Two unpublished clinical investigations comparing clobetasol propionate lotion 0.05% with clobetasol propionate cream 0.05% and emollient cream 0.05% in a total of 421 patients were also included. Results: In the 20 published and 2 unpublished trials identified and reviewed, the response rates were comparable between the lotion and cream formulations. In addition, in a psoriasis study, clobetasol lotion received significantly better cosmetic-acceptability ratings compared with clobetasol cream ( P < 0.05). Conclusion: In the studies reviewed, the effectiveness and tolerability of clobetasollotion were comparable to those of clobetasol cream and emollient cream in studies in adults with moderate to severe psoriasis or atopic dermatitis