What is known about use of clobetasol propionate in the treatment of lichen planus?

Fråga: What is known about use of clobetasol propionate in the treatment of lichen planus?

Sammanfattning: Clobetasol propionate is a potent (class IV) topical corticosteroid indicated for therapy resistant psoriasis. It is also effective in the treatment of lichen planus. Depending on the severity of skin manifestations, other treatment modalities or less potent topical corticosteroids may be more appropriate as a first-line therapy.

Svar: Clobetasol propionate is a superpotent topical corticosteroid which is available in the Swedish market as a 0.05 per cent ointment, cream or lotion (Dermovat). It is indicated in the treatment of therapy resistant exacerbation of psoriasis and other eczema (1). Due to its potency, skin atrophy, striae but also systemic side effects are of concern; hence, the drug should not generally be used in excessive amounts or for longer periods. Use of potent (class IV) topical corticosteroids in the initial treatment of isolated hyperkeratotic plaques is, however, widely accepted (2).

Lichen (ruben) planus is an inflammatory pruritic dermatosis of unknown etiology. Both systemic sedative antihistamines and topical corticosteroids will help to relieve itching but strong topical corticosteroids may be needed to improve the appearance of the rash (3). Occasionally, in generalized cases and if the rash is extensive, a systemic corticosteroid may even be required.

Clobetasol propionate is considered an effective topical treatment for various forms (lichen planus, lichen sclerosus et atrophicus) of the disease (4, 5). The potency (but also the risk for side effects) is even enhanced by occlusion with an adherent polytene dressing. In controlled clinical trials, clobetasol has also been found to be effective in vulval lichen sclerosus. Remission of symptoms occurred in 75 per cent of patients treated with clobetasol compared to 20 per cent treated with topical testosterone and to 10 per cent with progesterone (6). Also, the histologic evaluation showed a highly significant difference in favour of the clobetasol group. The authors consider topical treatment with potent steroids as the therapy of choice in vulval lichen sclerosus. Concerns about long-term safety have been raised, but clinical experience based on 12 cases with up to 39 months follow-up is not alarming (7). Apart from background erythema, no long term cutaneous side effects were observed in this small material.