The Role of a Midpotency Topical Corticosteroid and the Clinical Relevance of Formulation Characteristics in the Management of Commonly Encountered Eczematous and Inflammatory Dermatoses in Adults and Children:Focus on the Pharmacologic Properties of Clocortolone Pivalate 0.1% Cream
February 2013 | Volume 12 | Issue 2 | Supplement | s5 | Copyright © 2013
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb
aValley Hospital Medical Center, Las Vegas, NV; Las Vegas Skin and Cancer Clinics, JDRx Dermatology LLC, Henderson, NV; Touro University College of Osteopathic Medicine, Henderston, NV bMount Sinai Medical Center, New York, NY; Indiana University School of Medicine, Indianapolis, IN; Physicians Skin Care, PLLC, Louisville, KY
Midpotency topical corticosteroids (TCSs) are frequently used for the treatment of common eczematous and inflammatory skin disorders in both adults and children. There are several commercially available products in this category, and many vehicles and formulations for the clinician to choose from. Clocortolone pivalate 0.1% cream is a midpotency TCS formulated in an emollient formulation that has been shown to be effective and well tolerated when used appropriately in the management of several corticosteroid-responsive dermatoses. This article discusses the physiochemical properties of the compound; the characteristics of its emollient cream formulation; the functions of individual excipients; and the efficacy, tolerability, and safety data supporting its use in adults and children, including for facial involvement.
J Drugs Dermatol. 2013;12(2)(suppl):s5-s10.
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Overview of Clinical Considerations and Product Selection
The rational selection of a topical corticosteroid (TCS) is affected by several factors that may be related to the compound, the disease state, the type of vehicle, and the individual components and characteristics of the formulation.1-7 Compound-related factors include the individual corticosteroid compound and the concentration incorporated into the final formulation. Disease-state-related factors include the specific diagnosis, severity, and anatomic sites involved. The primary vehicle-related factors are the general category such as cream, lotion, ointment, gel, solution, or spray, and the aesthetic characteristics of the final product, especially as viewed by patients. Lastly, formulation- related factors include specific excipients incorporated to exert certain properties (eg, penetration enhancement, humectancy, occlusivity, solubilization, spreadability, emolliency, product preservation) and active ingredient release characteristics. Collectively, all of these factors influence the efficacy, skin tolerability, and patient acceptability of a given TCS formulation.
The midpotency TCS group includes several compounds and formulations that are frequently prescribed for the treatment of common dermatologic disorders such as atopic dermatitis (AD), irritant contact dermatitis, allergic contact dermatitis (ACD), seborrheic dermatitis (SD), and psoriasis (including chronic plaque psoriasis [CPP] and inverse psoriasis), as well as other eczematous dermatoses such as nummular eczema, asteatotic eczema, and stasis dermatitis. With the exception of CPP and lichenified eczematous plaques, which sometimes warrant treatment with a high-potency or superhigh potency TCS, most of the dermatoses mentioned above respond favorably within a reasonable time frame to a midpotency TCS that is adaptable for application and does not cause local irritation or cutaneous allergy.1,4,8 Several midpotency TCS formulations are available in the marketplace, including triamcinolone acetonide 0.1% cream and ointment, betamethasone valerate 0.1% cream and ointment, betamethasone valerate 0.12% foam, fluticasone propionate 0.05% cream and lotion, fluticasone propionate 0.005% ointment, hydrocortisone valerate 0.2% cream and ointment, hydrocortisone butyrate 0.1% cream and lotion, desoximetasone 0.05% cream, gel, and ointment, mometasone furoate 0.1% cream and solution, and clocortolone pivalate 0.1% cream.
This article provides a comprehensive review of clocortolone pivalate 0.1% (Cloderm® Cream; Promius Pharma, L.L.C., Bridgewater, NJ), which is a midpotency TCS emollient cream