Clobetasone Butyrate: Uses, Potency, Side Effects

What is clobetasone butyrate?

Clobetasone butyrate is a topical corticosteroid. In products such as Eumovate cream and ointment, it is present at a strength of 0.05%. It reduces inflammatory activity in the skin and can relieve redness, swelling and itching.

It is classified as moderately potent. That makes it stronger than mild hydrocortisone products, but it is not the same medicine as clobetasol propionate, which is a much more potent corticosteroid. Readers comparing strengths may also find this guide to topical hydrocortisone useful.

What is clobetasone butyrate used for?

The current Eumovate SmPC lists steroid-responsive dermatoses, including:

• atopic dermatitis and other forms of eczema;
• irritant or allergic contact dermatitis;
• seborrhoeic dermatitis;
• photodermatitis;
• inflammation caused by insect bites;
• certain forms of otitis externa, when directed by a clinician.

The medicine may also be used as maintenance treatment between courses of a more potent topical steroid when a clinician considers this appropriate.

How to apply it

For adults, older people, children and infants, the SmPC advises applying a thin layer to the affected area once or twice daily and rubbing it in gently. Use only enough to cover the affected skin.

Once the condition improves, reduce the frequency or change to a less potent treatment if advised. If the condition worsens or does not improve within four weeks, the diagnosis and treatment should be reassessed by a healthcare professional.

Occlusion and dressings

Covering treated skin with an airtight dressing increases absorption and the risk of side effects. Do not use occlusion unless a clinician specifically instructs you to do so. Nappies can act like occlusive dressings in infants.

Where should it not be used?

Do not use clobetasone butyrate for:

• untreated bacterial, fungal or viral skin infections;
• rosacea;
• acne vulgaris;
• itching without inflammation;
• perioral dermatitis;
• skin around the anus or genitals unless specifically prescribed;
• children under 12 years for dermatoses, including dermatitis, without medical supervision.

A topical steroid can mask or worsen an infection. If infection develops or spreads, contact a clinician; antimicrobial treatment may be required.

Special precautions

Face and eyelids

The face is more vulnerable to steroid-related thinning. Courses on facial skin should therefore be limited and medically supervised. Avoid the eyes. Repeated exposure of the eyelids can contribute to cataract or glaucoma.

Large areas, broken skin and long courses

Absorption increases when the medicine is used over a large area, on broken skin, in skin folds, under dressings or for a long time. Children and infants can absorb proportionally more through the skin and are more susceptible to systemic effects.

Vision changes

Report blurred vision or other visual disturbance. Rare eye complications have been associated with corticosteroid exposure and may need specialist assessment.

Side effects

Local burning, irritation, itching or allergic contact dermatitis can occur. Prolonged, excessive or occluded use may cause:

• skin thinning, stretch marks or visible small blood vessels;
• changes in skin pigmentation;
• increased hair growth;
• worsening of the underlying condition or secondary infection;
• rare systemic corticosteroid effects, including adrenal suppression or Cushing-like features.

Stop and seek medical advice if the skin reaction worsens, spreads or suggests an allergy or infection.

Topical steroid withdrawal reactions

The MHRA warns that a small number of people can develop topical steroid withdrawal reactions after long-term, frequent or inappropriate use, especially with moderate or stronger products. Symptoms may include intense redness extending beyond the treated area, burning, stinging, peeling or oozing after stopping.

Do not restart treatment repeatedly without medical advice if symptoms return shortly after stopping. A clinician should check whether this is a flare of the original condition, an infection, contact allergy or a withdrawal reaction.

Pregnancy and breastfeeding

There are limited data on clobetasone use during pregnancy. The SmPC states that it should be used only when the expected benefit justifies the potential risk, using the smallest amount for the shortest duration.

Use during breastfeeding has not been established as completely safe. If treatment is clinically needed, avoid applying it to the breast so that an infant cannot ingest the medicine, and use the minimum quantity for the shortest time.

Children and older adults

Children are more susceptible to systemic absorption. Courses should be limited and reviewed regularly; the SmPC advises that treatment in children should normally be restricted to five days and that occlusion should not be used unless directed by a clinician.

Older adults should also use the minimum effective amount, particularly when kidney or liver function is reduced or when large areas require treatment.

Frequently asked questions

Is clobetasone the same as clobetasol?

No. Clobetasone butyrate is moderately potent. Clobetasol propionate is a different, very potent corticosteroid. Their names are similar, but they are not interchangeable.

Can it be used as a moisturiser?

No. It treats inflammation and should be applied only to affected areas. An emollient can be used separately if recommended; allow time between products so one does not dilute or spread the other.

Can it treat a fungal rash?

Not by itself. Steroids can mask or worsen an untreated fungal infection. Obtain a diagnosis and use an appropriate antifungal treatment if advised.

Official sources

• Electronic Medicines Compendium: Eumovate Cream SmPC
• MHRA: topical corticosteroids and withdrawal reactions

This article provides general information and does not replace the patient leaflet or advice from a doctor or pharmacist.