Such an observation should be corroborated with appropriate diagnostic patch testing. Allergic contact dermatitis with corticosteroids is usually diagnosed by observing a failure to heal rather than noting a clinical exacerbation as with most topical products not containing corticosteroids. If irritation develops, clobetasol propionate cream and ointment should be discontinued and appropriate therapy instituted. Pediatric patients may be more susceptible to systemic toxicity from equivalent doses due to their larger skin surface to body mass ratios (see PRECAUTIONS: Pediatric Use). For information on systemic supplementation, see prescribing information for those products. Infrequently, signs and symptoms of glucocorticosteroid insufficiency may occur that require supplemental systemic corticosteroids. Recovery of HPA axis function is generally prompt upon discontinuation of topical corticosteroids. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent corticosteroid. Patients receiving super-potent corticosteroids should not be treated for more than 2 weeks at a time, and only small areas should be treated at any one time due to the increased risk of HPA suppression.Ĭlobetasol propionate cream and ointment produced HPA axis suppression when used at doses as low as 2 g/day for 1 week in patients with eczema. plasma cortisol, and urinary free cortisol tests. This may be done by using the ACTH stimulation, A.M. Patients applying a topical steroid to a large surface area or to areas under occlusion should be evaluated periodically for evidence of HPA axis suppression. Manifestations of Cushing syndrome, hyperglycemia, and glucosuria can also be produced in some patients by systemic absorption of topical corticosteroids while on therapy. Systemic absorption of topical corticosteroids can produce reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal from treatment. Clobetasol propionate cream and ointment should not be used in the treatment of rosacea or perioral dermatitis, and should not be used on the face, groin, or axillae.
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