INTRODUCTION
Topical corticosteroids (TCSs) are an integral component
of the therapeutic armamentarium of the dermatologist.
These agents are commonly used to treat a wide
variety of cutaneous disease states, such as atopic dermatitis
(AD), nummular eczema, contact dermatitis, seborrheic dermatitis,
psoriasis vulgaris, and stasis dermatitis. The selection
of a TCS is influenced by the anticipated responsiveness and
anatomic locations of the disease state involved, the potency of
the TCS formulation, and the characteristics of the vehicle formulation.
1-7 The collective factors that ultimately dictate TCS selection
by influencing the efficacy, skin tolerability, and patient
acceptability of a given TCS formulation are listed as follows:
Compound-related factors: The individual corticosteroid compound
and the concentration incorporated into the final formulation.
Disease-state related factors: The specific diagnosis, severity,
and anatomic sites involved.
Vehicle-related factors: 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.
Formulation-related factors: Specific excipients incorporated to
exert certain properties (ie, penetration enhancement, humectancy,
occlusivity, solubilization, spreadability, emolliency, product
preservation, etc.) and active ingredient release characteristics.
The mid-potency TCS category represents a group of commonly
prescribed agents that are used to treat a wide variety
of common dermatologic disorders such as 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.
In many cases, CPP and lichenified eczematous plaques
warrant treatment with a high-potency or super-high potency
TCS, at least initially. However, most of the cutaneous disorders
mentioned above respond favorably within a reasonable time
frame to a mid-potency TCS that is adaptable for application
and does not cause local irritation or cutaneous allergy.1,4,8-11
Among the currently available mid-potency TCS formulations
available in the marketplace in the United States, clocortolone
pivalate 0.1% cream has been available solely as a brand TCS
