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% (ClodermÂ® Cream; Promius Pharma, L.L.C., Bridgewater, NJ), which is a midpotency TCS emollient cream