Question

[sundaygirl]

I'm wondering if anyone here has tried a treatment I'm using...I think it's called Cormax liquid? I use a generic version, called clobetasol propionate. Anyway, I think I'm kind of growing immune to it. It takes more to make my p go away, and it doesn't stay away as long. Has anyone else had that problem on this medicine?

[MikeK]

Hi Kat,

I haven't used this particular medication, but I've have had the wonderful (NOT!) experience of having other meds suddenly stop working. It's almost of if the psoriasis suddenly decides to become resistant to certain treatments. To add insult to injury, something that stopped working today will suddenly start to work again a few weeks/months/years down the road. It can be very, very frustrating.

Mike

[PJ Leary]

Hi Kat,

Clobetasol prop. is a Class I steroid, the most potent that there is.

I would suggest rotating it's use with a Class II or Class III. Some examples of Class II topical steroids would be Elocon and Diprolene. Class III includes Aristocort and Halog, among others.

I while ago I posted an extnsive listing of the different steroids and their classifications of potency. Perhpas my friend Mike will come along and post a link for you to that thread. ( Thanks Mike )

You want to be careful using the clobetasol for longer than two weeks without taking a break. It can cause renal damage if usd too long or too extensively.

[MikeK]

Hi Kat,

For some strange reason, I haven't been able to find the thread that PJ referred to. I remember seeing it. It's a great thread, so I'm going to keep looking for it. In the meantime, I'm going to post a copy of the NPF's Topical Steroid Potency Chart at the end of this post.

As PJ mentioned, clobetasol propionate is listed as a Class 1 or Superpotent steroid. I echo her caution about prolonged use of something so strong. As she mentioned:

You want to be careful using the clobetasol for longer than two weeks without taking a break. It can cause renal damage if usd too long or too extensively.

Prolonged use of a Class 1 Steroid can also lead to skin thinning. (I use Ultravate (another Class 1 or Superpotent Steroid) and my derm limits its use to the weekends only because of its potential side effects.)

Hope this helps. Good luck. Keep us posted.

Mike

P.S. Here's a copy of the chart.

Steroid potency chart

The following potency chart categorizes brand-name topical steroid medications along with the name of the corresponding generic drug. The list is an illustration of how these medications are positioned according to their potency. The list may not be comprehensive.

BRAND NAME GENERIC NAME

CLASS 1 - Superpotent

Cormax Cream/Solution, 0.05% Clobetasol propionate
Diprolene Gel/Ointment, 0.05% Betamethasone dipropinate
Olux Foam, 0.05% Clobetasol propionate
Psorcon Ointment, 0.05% Diflorasone diacetate
Temovate Cream/Ointment/
Solution, 0.05% Clobetasol propionate
Ultravate Cream/Ointment, 0.05% Halobetasol propionate

CLASS 2 - Potent

Cyclocort Ointment, 0.1% Amcinonide
Diprolene Cream AF, 0.05% Betamethasone dipropionate
Diprosone Ointment, 0.05% Betamethasone dipropionate
Elocon Ointment, 0.1% Mometasone furoate
Florone Ointment, 0.05% Diflorasone diacetate
Halog Ointment/Cream, 0.1% Halcinonide
Lidex Cream/Gel/Ointment, 0.05% Fluocinonide
Maxiflor Ointment, 0.05% Diflorasone diacetate
Maxivate Ointment, 0.05% Betamethasone dipropionate
Psorcon Cream 0.05% Diflorasone diacetate
Topicort Cream/Ointment, 0.25% Desoximetasone
Topicort Gel, 0.05% Desoximetasone

CLASS 3 - Upper Mid-Strength

Aristocort A Ointment, 0.1% Triamcinolone acetonide
Cutivate Ointment, 0.005% Fluticasone propionate
Cyclocort Cream/Lotion, 0.1% Amcinonide
Diprosone Cream, 0.05% Betamethasone dipropinate
Florone Cream, 0.05% Diflorasone diacetate
Lidex-E Cream, 0.05% Fluocinonide
Luxiq Foam, 0.12% Betamethasone valerate
Maxiflor Cream, 0.05% Diflorasone diacetate
Maxivate Cream/Lotion, 0.05% Betamethasone dipropionate
Topicort Cream, 0.05% Desoximetasone
Valisone Ointment, 0.1% Betamethasone valerate

CLASS 4 - Mid-Strength

Aristocort Cream, 0.1% Triamcinolone acetonide
Cordran Ointment, 0.05% Flurandrenolide
Derma-Smoothe/FS Oil,
0.01% Fluocinolone acetonide
Elocon Cream, 0.1% Mometasone furoate
Kenalog Cream/Ointment/
Spray, 0.1% Triamcinolone acetonide
Synalar Ointment, 0.025% Fluocinolone acetonide
Uticort Gel, 0.025% Betamethasone benzoate
Westcort Ointment, 0.2% Hydrocortisone valerate

CLASS 5 - Lower Mid-Strength

Cordran Cream/Lotion/
Tape, 0.05% Flurandrenolide
Cutivate Cream, 0.05% Fluticasone propionate
DermAtop Cream, 0.1% Prednicarbate
DesOwen Ointment, 0.05% Desonide
Diprosone Lotion, 0.05% Betamethasone dipropionate
Kenalog Lotion, 0.1% Triamcinolone acetonide
Locoid Cream, 0.1% Hydrocortisone
Pandel Cream 0.1% Hydrocortisone
Synalar Cream, 0.025% Fluocinolone acetonide
Uticort Cream/Lotion, 0.025% Betamethasone benzoate
Valisone Cream/Ointment, 0.1% Betamethasone valerate
Westcort Cream, 0.2% Hydrocortisone valerate

CLASS 6 - Mild

Aclovate Cream/Ointment, 0.05% Alclometasone dipropionate
DesOwen Cream, 0.05% Desonide
Synalar Cream/Solution, 0.01% Fluocinolone acetonide
Tridesilon Cream, 0.05% Desonide
Valisone Lotion, 0.1% Betamethasone valerate

CLASS 7 - Least Potent

Topicals with hydrocortisone, dexamethasone,
methylprednisolone and prednisolone

[mama]

Hi Kat!

Right now I am using Olux foam. I am only allowed to use it for two weeks at a time. On my "off" week I use Luxiq foam.


MikeK is sooo right about the thinning of the skin. You must be careful!


I try to remember that when using these topical steroids---LESS IS MORE. I use them very sparingly. It's hard because you just naturally think " if I get it covered nice and thick, it'll really do a good job". Quite the opposite is true.


Good Luck!

[sundaygirl]

Great, now I'm really worried because my derm never told me not to use it for extensive periods, and he never said to use a certain amount. I've been prescribed this same stuff for a long time. What kind of damage can it cause?

On the up side, maybe I can sue and get rich.

[PJ Leary]

Hi Kat,

Mike is right about the thinning of the skin, I totally forgot to mention that. Mike's NPF chart is the same as the one in my previous post.

The limitation on clobetasol is 7 gms max per day, 14 days max time.

Our good friend golfin' Mama is also very right, less is more. We are all so used to slathering on more hoping it might actually work that we need to be re-conditioned for the proper use of this class of medication.

Also, many patients are never instructed on the proper method of application, which is very important. You want to take a very small amout on the tip of an applicator ( in the case of a lotion or other topical, the applicator can be anything from a Qtip to your gloved fingertip ) and apply the medication only to the spot or affected area in a circular clockwise motion until a thin coating is evenly applied. Do not get any medication on the surrounding skin. It is never a good idea to occlude, or tightly cover, a class 1 topical unless under the direct supervision and instruction of your Dr.

This is a long and painstaking procedure done properly for many people, depending on coverage and the difficulty of reaching those areas.

However, if one is going to use these types of medications to one's best advantage, it is worth the time to make them work as well as possible considering the short exposure times allowed. Biggest bang for your buck theory.

[sundaygirl]

Thanks for that info...but what can it do to the kidneys? And how long does it take for that damage to occur?

[MikeK]

Originally posted by sundaygirl
Thanks for that info...but what can it do to the kidneys? And how long does it take for that damage to occur?

I don't know about the kidneys, but the skin thinning problem came up fairly quickly in my case. As I mentioned in my initial reponse in this thread, I use Ultravate which is in the same superpotent Class 1 steroid classification as clobetasol propionate. I currently am using it on my hands, twice a day, on the weekends only. (I use Dovonex the rest of the week.) I used to use the Ultravate on my ankles, also only the weekends, in combination with Dovonex. When I was using it on my ankles, my derm was so concerned about the skin thinning issue that she had me come in for check ups every six weeks instead of my normal every six month cycle. She said that she saw evidence of skin thinning, on my ankles, less then a year after I first started using it. Now that I'm only using it on my hands, I'm back to going in every six months.

Mike

[sundaygirl]

Wow...does anyone have any info on the kidney damage thing?

[sundaygirl]

Can someone please help? I've been using this medication for a long time without proper instruction or supervision, and I'm really worried.

[khorath]

I, too, have never heard of clobetasol affecting the kidneys. PJ and Mike have pretty well listed the pros and cons of using clobetasol.

If you really are that concerned and think you may have abused (unknowingly) clobetasol, call your doctor. She/He should be able to give you the specific help you need!

Good luck!

[chaimFL]

Sundaygirl....how long did you use clobetasol for continuosly?? It's highly unlikely that you have any kidney damage from it as that is very rare with topical use if steroids. I've used topical steroids off and on for a pretty long time and have never had an issue.....currently I'm swearing off topical steroids as I think they do more bad than good in the long run (and I'm not referring to kindey damage).

[sundaygirl]

I've used it at least a few times a week, fairly regularly, for about 3 years.

What bad were you referring to, if not kidney damage?

[chaimFL]

Most common is skin thinning, which I have not had an issue with.....but here's a ling to all the potential side effects if you want to know....and by the way I've been using topical steroids on and off for up to a month at a time for over 10 years so don't be too concerned.

http://health.yahoo.com/health/drug/202016/precaution

[MikeK]

Originally posted by MikeK
For some strange reason, I haven't been able to find the thread that PJ referred to. I remember seeing it. It's a great thread, so I'm going to keep looking for it.

It took a while but I finally referred to the post the PJ referred to. LOL. Here's a link to it: http://www.psoriasis.org/forum/showt...ocoid+Solution. It's identical to the information that I posted earlier in this thread. I'm posting it again, because you it's some information can never be repeated often enough in my opinion.

Mike

[Kimbercat]

Originally posted by MikeK
It took a while but I finally referred to the post the PJ referred to. LOL. Here's a link to it: http://www.psoriasis.org/forum/showt...ocoid+Solution. It's identical to the information that I posted earlier in this thread. I'm posting it again, because you it's some information can never be repeated often enough in my opinion.

Mike

DARN!!!!

And I thought I finally caught Mike with another linkless post! Guess I wasn't fast enough! FlakeyMatt still has the record!

[vlfriscia]

Yes, sundaygirl, I have had the same experience with the clobetasol. Unfortunately, as I have used it for years in conjunction with a coal tar/peanut oil solution, neither of which is working now. I always used it sparingly for SCALP psoriasis only, and have never experienced any adverse symptoms. My derm would mention potential side effects from time to time when refilling my prescription, so I was aware that you are not supposed to use it indefinitely, but I never had any symptoms. I have continued to use it because, as MikeK says, sometimes these things quit working and then spontaneously start working again. That's what I am hoping for this time around.

Victoria

[nitegale]

The major problem with using topical steroids for too long, especially the superpotent ones, is that they can become absorbed through the skin and have a similar adverse effect of supressing your immune system as does taking the steroid orally. This can pose a great danger to your health especially when it comes to fighting an infection.

The other problem with using topical steroids for too long is that tachyphylaxis can occur, where by the effect of the treatment becomes diminished in time.

Also, my derm suggest the best way to apply an ointment to your skin is by using a small amount with a little water and rubbing only onto the lesion. The water helps transfer the ointment into the plaque lesion. Make sure you rub gently and and let all the water absorb.

Good Luck!