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Clobetasol vs Hydrocortisone
Introduction
For patients suffering from various skin conditions, such as psoriasis or eczema, certain topical medications that have a potent anti-inflammatory and immunosuppressive effect can help in reducing inflammation and managing symptoms. Clobetasol and Hydrocortisone are two such drugs that are often prescribed for these conditions. They each impact different inflammatory pathways but both have significant effects in reducing skin inflammation.
Clobetasol is classified as a very high-potency topical corticosteroid, making it suitable for severe or resistant cases due to its stronger effectiveness. It works by suppressing the immune response, thereby reducing inflammation and related symptoms.
On the other hand, Hydrocortisone is considered a low-potency steroid which makes it less likely to cause side effects when compared to clobetasol. Primarily used for mild to moderate skin conditions because of its safer profile, hydrocortisone also reduces swelling, itching and redness associated with many skin diseases.
Clobetasol vs Hydrocortisone Side By Side
| Attribute | Dermovate | Cortizone westcort |
|---|---|---|
| Brand Name | Dermovate | Cortizone, Westcort |
| Contraindications | Worsening of skin infections, use with certain antifungal drugs, prolonged use around the eyes. | Worsening of skin infections, use with certain antifungal drugs, prolonged use around the eyes. |
| Cost | For brand-name Clobetasol Propionate (0.05%), around $150 for a 15g tube. Generic versions cost between $1 and $2 per gram. | For brand-name Hydrocortisone cream (2.5%), about $50 for a similar size tube. Generic versions can be as low as 30 cents to about 90 cents per gram. |
| Generic Name | Clobetasol Propionate | Hydrocortisone |
| Most Serious Side Effect | Adrenal gland issues, skin infection signs, allergic reactions, stretch marks, thinning of the skin, weight gain, vision problems. | Allergic reactions, severe skin irritation, signs of skin infection, high blood sugar, possible adrenal gland problems. |
| Severe Drug Interactions | Certain antifungal drugs. | Certain antifungal drugs. |
| Typical Dose | Applied in a thin layer to the affected area twice daily, not to exceed two weeks. | Applied in a thin layer to the affected area once or twice daily, depending on severity. |
What is Clobetasol?
Clobetasol (marketed under various brand names such as Dermovate) represents a significant development in the class of drugs known as topical corticosteroids. This highly potent medication was first approved by the FDA in 1985 and is typically prescribed for treating severe inflammatory skin conditions, such as eczema or psoriasis. Clobetasol works by reducing swelling, redness, itching - all typical symptoms associated with these conditions. It achieves this through its powerful anti-inflammatory action that inhibits the body's overactive immune responses causing these symptoms.
On the other hand, Hydrocortisone is considered a mild to moderate potency corticosteroid and has been available for much longer than clobetasol. While it also decreases inflammation and itching, its lower potency makes it suitable for less severe conditions or sensitive areas of skin like face or groin.
Clobetasol's more potent effect comes at a price: it carries higher risks of side effects if used improperly or over an extended period. These may include thinning or discoloration of the skin among others while hydrocortisone has fewer side effects when used correctly under supervision.
What conditions is Clobetasol approved to treat?
Clobetasol is approved for the treatment of several skin conditions, including:
- Psoriasis, a condition causing cells to build up rapidly on the surface of the skin
- Eczema, a group of diseases that results in inflammation of the skin
- Lichen Planus, an inflammatory condition affecting mucous membranes and your skin.
- Dermatitis or rash caused by contact with certain substances It's worth noting that Clobetasol is meant for short-term use due to its potency.
How does Clobetasol help with these illnesses?
Clobetasol is a potent corticosteroid that helps manage inflammatory and pruritic symptoms of dermatoses by reducing the production of chemicals in the body that cause inflammation. It does this by binding to glucocorticoid receptors within cells, which inhibits pro-inflammatory proteins and promotes anti-inflammatory proteins. This leads to a reduction in swelling, redness, itchiness and discomfort often seen with skin conditions like eczema or psoriasis.
Hydrocortisone also acts similarly but it's less potent than Clobetasol. It binds to the same glucocorticoid receptor and elicits similar effects on cellular protein synthesis; however, due to its lower potency compared to Clobetasol, Hydrocortisone is used for less severe skin conditions such as rashes or bug bites. Therefore, depending on the severity of your condition your doctor may prescribe either one of these medications.
What is Hydrocortisone?
Hydrocortisone is a topical steroid that reduces inflammation in the body, making it effective for treating a variety of skin conditions. It's often sold under brand names such as Cortizone and was first approved by the FDA in 1952. Hydrocortisone works by suppressing the immune response in the skin, thereby reducing inflammation, itching, and redness. Unlike clobetasol which is a very potent corticosteroid usually reserved for severe or resistant skin disorders, hydrocortisone has a milder potency making it suitable for over-the-counter use and treatment of less severe inflammatory conditions. Its lower potency also means that its side-effect profile differs from that of more potent steroids like clobetasol – it's less likely to cause thinning of the skin (atrophy), although this can still occur with prolonged use. The anti-inflammatory effects can be beneficial in managing various dermatological issues such as eczema or psoriasis where patients may not require or tolerate stronger steroids like clobetasol.
What conditions is Hydrocortisone approved to treat?
Hydrocortisone is a widely recognized topical medication that has received FDA approval for its effectiveness in treating a variety of skin conditions such as:
- Eczema, which includes symptoms like dryness and recurring skin rashes
- Dermatitis, including contact dermatitis caused by exposure to certain substances
- Psoriasis, an autoimmune disease characterized by patches of abnormal skin
- Itchiness or inflammation from insect bites.
How does Hydrocortisone help with these illnesses?
Hydrocortisone is a type of corticosteroid that plays roles in many processes in the body, including reducing inflammation and suppressing immune responses. Much like cortisol, a hormone naturally produced by the adrenal glands during times of stress, hydrocortisone works to decrease swelling and redness often associated with skin conditions such as eczema or dermatitis. Its action on glucocorticoid receptors can also help alleviate symptoms associated with allergic reactions or autoimmune diseases. While it does not significantly affect mineralocorticoid levels (as clobetasol may do), hydrocortisone is often prescribed when a patient requires mild to moderate relief from skin irritations. Additionally, it may be combined with other treatments for comprehensive care.
How effective are both Clobetasol and Hydrocortisone?
Both clobetasol propionate and hydrocortisone have well-established histories of success in treating skin conditions such as eczema and psoriasis, among others. Clobetasol was first approved by the FDA in 1985 while hydrocortisone has been available over-the-counter since the early 1950s. They both belong to a class of medications called corticosteroids which work by reducing inflammation, itching, and redness.
Clobetasol is typically used for severe or resistant inflammatory skin conditions due to its high potency whereas hydrocortisone is considered a low-potency steroid making it suitable for less severe cases or sensitive areas like face and groin. A 2008 study comparing clobetasol propionate to hydrocortisone butyrate in patients with atopic dermatitis found that both were effective though clobetasol had more pronounced improvement on erythema (redness) after two weeks.
A review from 2011 highlights the effectiveness of topical corticosteroids including clobetasol propionate in managing various dermatological disorders starting from the first week of treatment. It also highlighted some possible side effects including thinning of skin if overused.
On the other hand, a meta-analysis done in 2013 showed that low-potency corticosteroids like hydrocortisone are equally effective compared to placebo when used correctly. Hydrocortisone preparations are commonly recommended as first-line treatment options for mild-to-moderate eczema flares due to their favorable safety profile.
The evidence pointing towards significant benefits with use of higher potency steroids like clobetasol over lower ones such as hydrocortisone is still generally lacking hence one should be chosen based on individual patient needs considering factors such as age, severity, location and extent of disease.
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At what dose is Clobetasol typically prescribed?
Topical doses of Clobetasol are typically applied in a thin layer to the affected area twice daily, but it should be noted that this is a potent corticosteroid and its use should not exceed two weeks. Children can also use clobetasol under strict medical supervision, however its usage duration should be even more limited due to higher absorption rates. Hydrocortisone on the other hand, being a mild topical steroid, may be used up to 2-3 times per day for adults. For children and adolescents, consult with your healthcare provider for proper dosage instructions as it varies based on age and condition severity. Dosage adjustments can be made after assessing individual response over time.
At what dose is Hydrocortisone typically prescribed?
Hydrocortisone treatment typically begins with the application of a thin layer to the affected area once or twice daily, depending on severity. The dose can then be adjusted as per your doctor's advice and based on the response to initial treatment. Hydrocortisone is generally used for mild skin conditions; therefore, long-term use or use in larger amounts should be avoided unless specifically advised by a healthcare professional. It's important not to exceed usage beyond two weeks without consulting with your healthcare provider because overuse may lead to adverse effects such as skin thinning.
What are the most common side effects for Clobetasol?
Common side effects of Clobetasol, a potent corticosteroid, include:
- Burning or stinging at the application site
- Skin dryness, itching, redness
- Unwanted hair growth
- Inflammation and/or infection of the hair follicles
- Lightening of skin color
Hydrocortisone is a mild corticosteroid and can cause these common side effects:
- Mild burning, stinging or itching at the application site
- Dry or cracking skin
- Acne
- Changes in skin color -Skin rash
Always remember to contact your healthcare provider if you experience any unusual symptoms after using these medications.
Are there any potential serious side effects for Clobetasol?
In some rare cases, Clobetasol can cause potentially serious side effects which include:
- Signs of skin infection such as swelling, redness, heat or pain in the area where you applied clobetasol
- Allergic reactions including hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Worsening of your skin condition
- Stretch marks or thinning of the skin
- Weight gain especially around the midsection and upper back region.
Less common but more severe side effects may include adrenal gland issues manifesting as tiredness that doesn't go away, severe nausea or vomiting and lack of appetite.
If any vision problems occur (like blurred vision, seeing halos around lights), this could be a sign of an eye disease called cataract/glaucoma induced by steroid usage. If these symptoms are observed it is important to seek immediate medical attention. As with all medications if you have any concerns about potential side effects it is vital to consult with your healthcare provider before starting treatment.
What are the most common side effects for Hydrocortisone?
Hydrocortisone, while often milder than Clobetasol, can still have potential side effects that include:
- Dryness or cracking of the skin
- Acne or other types of skin blemishes
- Lightening in color of treated areas (hypopigmentation)
- Burning sensation at application site
- Itching and irritation of the skin
- Increased body hair growth (hypertrichosis) In more severe cases, Hydrocortisone use could lead to systemic side effects such as weight gain, fluid retention, high blood pressure and glucose intolerance. Remember to always apply topical steroids as directed by your healthcare provider to minimize potential adverse events.
Are there any potential serious side effects for Hydrocortisone?
While Hydrocortisone is generally well-tolerated, it can sometimes cause severe side effects in certain individuals. Some of the more serious symptoms to look out for include:
- Signs of allergic reaction such as hives, difficulty breathing, swelling of your face or throat
- Skin redness or scaling that gets worse or does not improve within a few days
- Symptoms of skin infection like swelling, warmth, pus or oozing
- Severe irritation where the medication was applied
- High blood sugar--increased thirst, increased urination, dry mouth, fruity breath odor
- Possible adrenal gland problems--tiredness or weakness that doesn't go away after adequate rest and sleep; lack of appetite; weight loss
If you experience any of these symptoms while using hydrocortisone topical cream, discontinue use and seek immediate medical attention.
Contraindications for Clobetasol and Hydrocortisone?
Both clobetasol and hydrocortisone, along with most other topical steroids, may worsen symptoms of skin infection in some people. If you notice your condition worsening or an increase in redness, swelling or pus formation while using these medications, please seek immediate medical attention.
Neither clobetasol nor hydrocortisone should be used if you have been taking certain antifungal drugs that can interact negatively with them. Always tell your physician which medications you are taking; some drugs will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with clobetasol and hydrocortisone.
Furthermore, avoid use around the eyes unless prescribed by a doctor as prolonged usage could lead to glaucoma or other serious conditions. It is also important to apply these substances sparingly; excessive application can lead to thinning of the skin over time.
How much do Clobetasol and Hydrocortisone cost?
For the brand name versions of these drugs:
- The price of a 15g tube of Clobetasol Propionate (0.05%) averages around $150, which works out to roughly $10/day, assuming usage of one gram per day.
- The price for a similar size tube of Hydrocortisone cream (2.5%) is significantly less at about $50 or approximately $3.33/day under the same daily dosage.
Therefore, if you are using an equivalent amount daily, then brand-name Hydrocortisone is less expensive on a per-day treatment basis than Clobetasol Propionate. However, cost should not be your primary consideration in determining which drug is right for you.
As for generic versions of clobetasol and hydrocortisone creams:
- Generic Clobetasol Propionate (0.05% topical ointment) typically costs between $1 and $2 per gram if purchased in larger tubes
- Generic Hydrocortisone (2.5% topical cream), on the other hand can be obtained at prices as low as 30 cents to about 90 cents per gram.
Again, it's important to note that while cost considerations are important, they should not override effectiveness and side-effect profiles when choosing between these two medications.
Popularity of Clobetasol and Hydrocortisone
Clobetasol, available under brand names such as Dermovate, was estimated to have been prescribed to about 2.7 million people in the US in 2020. Clobetasol accounted for just over 10% of topical corticosteroid prescriptions in the US. However, it appears to be one of the most potent “super high” potent class corticosteroids (not classified as a mild or moderate potency steroid). The use of clobetasol has seen an uptick since 2013 due to its efficacy against severe dermatological conditions.
Hydrocortisone, including brand versions such as Cortizone-10 and Westcort, was prescribed to approximately 9 million people in the USA in 2020. In the US, hydrocortisone accounts for just under 35% of mild potency corticosteroid prescriptions and around 20% overall topical corticosteroid prescriptions. The prevalence of hydrocortisone has held steady over recent years thanks mainly due to its safety profile and wide-ranging applications from insect bites and poison ivy reactions through eczema flares.
Conclusion
Both clobetasol and hydrocortisone have long-standing records of usage in patients with inflammatory skin conditions, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. They belong to the class of drugs known as corticosteroids, which work by reducing inflammation, itching, and redness. Clobetasol is a high potency steroid typically used for severe cases or resistant lesions due to its greater anti-inflammatory capabilities compared to hydrocortisone.
On the other hand, hydrocortisone is a low potency steroid usually considered a first-line treatment option for mild-to-moderate dermatoses. It's often prescribed when there's need to avoid potential side-effects associated with stronger steroids such as clobetasol.
Both drugs come in generic forms offering significant cost savings especially for patients paying out-of-pocket. Both may require an adjustment period meaning that full symptom relief might not be immediately noticeable.
The side effects between these two medications differ significantly because of their respective potencies; clobetasol carries higher risks including skin thinning and adrenal suppression especially if used on large areas or under occlusion. For both drugs, patients must closely monitor any changes in their condition while under treatment and should seek medical help immediately if symptoms persist or worsen.
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Refrences
- Lassus, A. (1979, January). Clobetasone butyrate and hydrocortisone butyrate in the treatment of eczema: a double-blind comparison. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/03007997909109415