Clobetasol: potent steroid cream, ointment, shampoo and scalp treatment

Clobetasol is a very potent skin steroid, available only on prescription. The NHS lists eczema, psoriasis, lichen planus and lupus, with discoid lupus erythematosus named among them, as the conditions it treats. There is also a combined product that adds an antibiotic and an antifungal for skin problems at risk of infection. Dermovate and Etrivex are the brands listed.

It is made as a cream, an ointment, a shampoo and a scalp treatment. Which one you are given depends on the area: shampoo and scalp products are for the scalp, while creams and ointments go on the skin elsewhere.

Like other steroid medicines, it reduces inflammation and swelling in the skin. The difference is potency: the NHS describes it as much stronger than other steroid treatments, and the side effects described below are the reason for the time limits in the NHS advice.

That is the reason milder products are tried first and clobetasol is kept for short, specific courses. If treatment has to continue, the doctor may suggest a milder steroid.

It is not suitable if you have had an allergic reaction to clobetasol or other steroids, or if you have acne, rosacea, an active skin infection, broken skin or cuts, or itchy skin that is not inflamed or red. Age limits apply: the cream, ointment and scalp treatment are not for children under 1 year, and the shampoo is not for children under 2 years.

Creams and ointments are applied once or twice a day in a thin layer, rubbed in gently, and measured in fingertip units. The scalp treatment is used twice a day, in the morning and the evening, and should be left uncovered; a hairdryer should not be used afterwards. The shampoo is used once a day: massage it onto dry scalp, leave it for 15 minutes, then rinse.

Wait about 30 minutes before putting on other creams or moisturisers. Do not use it for more than 4 weeks without checking with your doctor, and keep facial use to a maximum of 5 days because facial skin thins easily with this medicine.

If you miss an application, use it when you remember unless the next is near, and never double up. Occasional overuse is not an emergency, but regular overuse increases risk.

Common effects are burning, pain, irritation or itching where it is applied, thinner skin and small red blood vessels showing on the surface.

Serious effects are less common and become likelier with prolonged use. They include anaphylaxis, underactive adrenal glands (vomiting, weakness, loss of appetite, dizziness), Cushing's syndrome (weight gain, puffy face, muscle weakness) and pus-filled bumps under the skin.

• Call 999 if you think you are having anaphylaxis.

• Call NHS 111 for other serious side effects.

• Speak to a pharmacist or doctor if common effects continue or worry you.

• Report suspected side effects through the Yellow Card scheme.

Stopping suddenly after a long course can trigger a withdrawal reaction: redness, burning or stinging, intense itching, peeling skin and oozing sores. Doctors therefore reduce the dose gradually. Do not stop on your own after prolonged use, and ask before restarting after a break.

Check with a healthcare professional before use in pregnancy; most types can be used, with the smallest amount for the shortest time. It is generally safe while breastfeeding, but wash it off the breasts and nipples before a feed, and babies rarely have side effects.

Other medicines are unlikely to interfere, there is no alcohol restriction, and clobetasol does not usually affect driving or using machinery. Do not use it on cuts or wounds, do not cover treated skin with dressings, and keep away from naked flames because of flammability.