Clobetasol for Hair Loss

Clobetasol for Hair Loss: What's that all about?

Clobetasol is the  name give to a potent topical corticosteroid. It is also known by its longer proper  name "clobetasol proprionate." Corticosteroids are medications which reduce inflammation. Clobetasol is available as a cream, ointment, lotion, foam and shampoo.

I often prescribe clobetasol for patients with hair loss conditions that are associated with inflammation. In fact, rarely does a day go by that I have not written a prescription for clobetasol. Alopecia areata, scarring alopecias, psoriasis, eczemas, dermatitis, all have the potential to benefit in some way with use of topical clobetasol. 

Clobetasol is never 'just because'

Clobetasol is not a good option for hair and scalp conditions that are not associated with inflammation. One should not use clobetasol "just because" and one should not use clobetasol or any topical steroid unless there is evidence of inflammation either clinically (the patient has symptoms) or histologically (the biopsy shows inflammation).  While the statement "my friend used clobetasol and it helped her- should I use it?" is understandable, it is simply not helpful when deciding if this medication is appropriate for a given person.

Clobetasol is a strong steroid

Clobetasol is among the most potent of topical steroids.  I can't emphasize enough the need to respect these medications. Despite what I hear everyday, these medications simply can't be dumped on the scalp and the scalp simply cannot be "soaked completely." That increases the chances of side effects. Unless you see a lot of patients with hair loss, it's challenging to appreciate the side effects that really can happen.

Long term side effects of potent topical steroids are well known but often ignored because side effects happen so infrequently. But potential side effects include: adrenal suppression, acne, hair loss, cataracts, bone loss, stretch marks, diabetes, persistent red scalp and "rebound" when trying to taper these medications.  I'll agree with anyone who says these are fairly uncommon. But I would challenge anyone who says they don't occur.

In modern medicine, we see side effects more commonly with oral steroids (like Prednisone and dexamethasone) followed by steroid injections (like triamcinone acetonide) followed by topical steroids. Even topical steroids have a range of safety with weak steroids like hydrocortisone being much safer overall than strong steroids like clobetasol.

Conclusion

Without clobetasol and similar potent topical steroids, I would not be able to fight inflammation the way I need to. These medications are extremely valuable. Nevertheless, these medications need to be respected.