A Review of Topical Corticosteroid Foams

August 2019 | Volume 18 | Issue 8 | Original Article | 756 | Copyright © August 2019

Jessica Payne BS,a Kyle A. Habet MD,ª Adrian Pona MD,ª Steven R. Feldman MD PhDa,b,c

ªCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC cDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC

Abstract
Background: Topical corticosteroids are efficacious treatment options for multiple dermatoses. However, ointments and cream corticosteroid vehicles can be cumbersome to patients and may act as a barrier to adherence. Foam vehicles may be preferred by some patients. Objective: To evaluate the efficacy and safety of topical corticosteroid foams.

Methods: A literature review was conducted using the keywords “clobetasol,” “betamethasone,” “propionate,” “valerate,” “topical,” “foam,” “vehicles,” “desonide,” and “clinical trial.” Thirty-seven articles were chosen.

Results: For moderate plaque-type psoriasis, 68% of subjects using clobetasol propionate foam achieved a Physician Static Global Assessment score of 0 or 1 at week 2 compared with 21% in the control group (P<0.0001). For betamethasone valerate (BMV) foam, a 12-week regimen for alopecia areata yielded a mean Investigator Global Assessment score of 2.9 compared with placebo (4.6; P<0.001) and achieved ≥75% hair regrowth in 42.86% of subjects. Furthermore, BMV foam cleared or almost cleared 72% of scalp psoriasis subjects compared with BMV lotion (P≤0.005%). For calcipotriol plus betamethasone dipropionate foam, 38.3% of psoriasis subjects achieved treatment success compared with placebo (22.5%; P<0.001). Desonide 0.05% foam was superior to vehicle foam in pediatric atopic dermatitis subjects.

Conclusion: Topical corticosteroid foams can be used for a variety of corticosteroid-responsive dermatoses. Topical corticosteroid foams are generally easy to apply and may improve patient adherence and, therefore, clinical outcome in patients who prefer a convenient and less messy topical therapy.

J Drugs Dermatol. 2019;18(8):756-770.

INTRODUCTION

Topical corticosteroid ointments, creams, and lotions are efficacious treatments for multiple dermatoses.1 However, adherence to these treatments is often abysmal.2,3 Individualizing treatments based on patient preference may improve adherence, patient satisfaction, and clinical outcome.4,5 

Other vehicle formulations may be preferred by some patients. Foams are generally easy to apply and cosmetically appealing.1,5 Although patient preference for different vehicles is variable, foams may improve some patients’ treatment satisfaction.5-7

Four topical corticosteroid foams are available – clobetasol propionate (CP) 0.05% foam, betamethasone valerate (BMV) 0.12% foam, calcipotriol 0.005% plus betamethasone dipropionate (Cal/BD) 0.064%, and desonide 0.05% foam (Table 1). The purpose of this study was to evaluate the efficacy and safety of CP, BMV, Cal/BD, and desonide foams in dermatologic diseases.

METHODS

A Pubmed search was conducted up to April 1, 2019 using the keywords: “clobetasol,” “betamethasone,” “dipropionate,” “valerate,” “corticosteroids,” “desonide,” “topical,” “foam,” “vehicles,” “treatment,” and “clinical trial.” Forty articles out of 314 results were selected and read related to relevance (Figure 1).

RESULTS

Clobetasol Propionate 0.05% Foam
Clobetasol propionate 0.05% foam is a super-potent topical corticosteroid indicated for treating mild-to-severe plaque-type psoriasis and other corticosteroid-responsive dermatoses in patients 12 years and older. A thin layer is applied twice daily for up to 2 weeks, with a maximum weekly dose of 50 mg.8

Efficacy
A randomized, double-blind, placebo-controlled study stratified plaque-type psoriasis subjects to either CP 0.05% foam or vehicle foam applied twice daily for 2 weeks. At week 2, more CP