Clobetasol Shampoo: A Helpful Consideration for Stubborn Scalp Seborrheic Dermatitis

Addition of Clobetasol Shampoo to a Treatment Plan for Moderate to Severe Seborrheic Dermatitis makes Good Sense

Seborrheic dermatitis is an inflammatory scalp condition that is mutlifactorial in its ethology. Malassezia yeasts have a clear role to help drive scalp inflammation. Treatment of scalp seborrheic dermatitis typical involves use of antidandruff shampoos. Short term use of topical steroids can also be helpful to quickly reduce inflammation..

Clobetasol shampoo is helpful to add to many treatment plans. Two studies are important to review as they remind us of the benefits of these shampoos.

The combination of a prescription based corticosteroid and a traditional dandruff shampoo is often helpful in cases of treatment resistant seborrheic dermatitis.

Reygagne et al, 2007

This was a multicenter, randomized, investigator-blinded, parallel-group pilot study was to evaluate the efficacy and safety of clobetasol propionate shampoo 0.05% after different short-contact application times compared with its vehicle and ketoconazole foaming gel 2% in the treatment of SD of the scalp.

For 4 weeks, 55 subjects received one of the following treatments twice weekly:

a) clobetasol propionate shampoo for 2.5 minutes

b) clobetasol propionate shampoo for 5 minutes

c) clobetasol propionate shampoo for 10 minutes;

d) clobetasol propionate vehicle for 10 minutes;

e) ketoconazole foaming gel for 5 minutes before rinsing off.

The study showed that application of clobetasol shampoo for 5 and 10 minutes produced a similar decrease in total severity score to the Ketoconazole gel.. Mean itching scores were reduced in both clobetasol shampoo groups and ketoconazole groups compared to vehicle controls. Interestingly, complete clearance of SD was highest overall in the 10 minute contact clobetasol shampoo group and was higher than the Ketoconazole group or the 5 minute or 2.5 minute clobetasol shampoo group.

The conclusion of the Reygagne study of 2007 was the clobetasol shampoo for short contact times can be helpful in the treatment of seborrheic dermatitis

Ortonne et al, 2011

Although the Reygagne study of 2007 taught us that clobetasol shampoo has benefit in treating seborrheic dermatitis, the Ortonne study of 2011 taught us that combining clobetasol shampoos with traditional antidandruff shampoo is probably the way to proceed.

The study set out to evaluate the efficacy and safety of clobetasol shampoo alone and combined with ketoconazole shampoo 2% (KC) in the treatment of moderate to severe scalp seborrhoeic dermatitis.

This was a randomized and investigator-blinded study and consisted of three phases, each lasting 4 weeks. During the treatment phase of four weeks duration, subjects were randomized to receive one of the following:

a) Ketoconazole shampoo twice weekly

b) Clobetasol shampoo twice weekly

c) Clobetasol shampoo twice weekly alternating with Ketoconazole shampoo twice weekly

d) Clobetassol shampoo four times weekly with Ketoconazole shampoo twice weekly.

All subjects received KC once weekly during the subsequent 4 week maintenance phase and were untreated during the follow-up final 4 week phase.

Results showed that at the end of the first four week ‘treatment phase’, all three clobetasol shampoo-containing regimens were significantly more efficacious than ketoconazole shampoo alone in decreasing the overall disease severity (P < 0·05). Both of the combination regimens were also significantly more efficacious than ketoconazole shampoo alone in decreasing each individual sign of the disease (P < 0·05).

The combination of twice weekly clobetasol and twice weekly ketoconazole was best plan of all. The clobetasol shampoo alone group and the clobetasol four times weekly with ketoconazole twice weekly group lead to a slight worsening during the maintenance phase.

Interestingly, the efficacy was sustained in the twice weekly clobetasol and twice weekly ketoconazole group and remained the highest compared to all the other groups.

The conclusion of the Ortonne et al 2011 study was that combination therapy with twice-weekly clobetasol shampoo alternating with twice-weekly ketoconazole shampoo provided significantly greater efficacy than ketoconazole alone and had sustained effect in the treatment of moderate to severe scalp seborrhoeic dermatitis.

Conclusion

The use of topical steroids are very much a part of the management of refractory seborrheic dermatitis. They are not necessarily first line - and most patients with seborrheic dermatitis are better off starting with traditional dandruff shampoos given how well they work for most. However, if seborrheic dermatitis fails to respond, and one is 100 % certain the diagnosis is correct, use of topical steroids is very reasonable.

See “Diagnosis & Management of Seborrheic Dermatitis”



REFERENCE

Ortonne JP et al. Efficacious and safe management of moderate to severe scalp seborrhoeic dermatitis using clobetasol propionate shampoo 0·05% combined with ketoconazole shampoo 2%: a randomized, controlled study. Br J Dermatol 2011 Jul;165(1):171-6.

Reygagne et al. Clobetasol propionate shampoo 0.05% in the treatment of seborrheic dermatitis of the scalp: results of a pilot study. Cutis. 2007 May;79(5):397-403.