Q:I have been using Dermovate ointment for the treatment of psoriasis for a number of years. Can you tell me if prolonged use can give rise to side effects that carry some risk of permanent damage to health? G. H. Sampson, Beckenham, Kent.
A:It certainly can, according to its manufacturers, Glaxo Laboratories. Dermovate cream and ointment is made up of a drug called clobetasol propionate, which the manufacturer describes in the Datasheet Compendium as a "very active topical corticosteroid which is of particular value when used in short courses for the treatment of more resistant dermatoses such as psoriasis (excluding widespread plaque psoriasis)." (italics mine.)Glaxo goes on to say that Dermovate should be applied sparingly to the affected areas once or twice a day until you see improvement and then usage stopped. If things don't get better after two to four weeks, you should seek another diagnosis or treatment.
"Repeated short course of Dermovate may be used to control exacerbations," Glaxo continues. "If continuous steroid treatment is necessary, a less potent preparation should be used."
In other words, this is the steroid of steroids, which is used only as a last resort and then only for a short course of a month or more.
Under "Precautions", Glaxo states: "Long term continuous topical therapy should be avoided where possible, particularly in infants and children, as adrenal suppression can occur readily." that is, harm to the adrenal glands.
The company also warns against using the drug on the face for more than five days. Use for longer than that might cause "atrophic changes" ie, atrophy of the tissues. You should also avoid using it around the eyes, because it can cause glaucoma.
"Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses, development of tolerance, risk of generalized pustular psoriasis and development of local or systemic toxicity due to impaired barrier function of the skin. If used in psoriasis careful patient supervision is important," warns Glaxo.
In other words, the drug itself may be setting up a vicious cycle, causing your psoriasis to worsen.
In the Physician's Desk Reference, Glaxo warns in bold type that the drug will cause Cushing's Syndrome, or excessive secretion of the adrenocorticotrophic hormone (ACTH) by the pituitary gland, leading to the deposit of fat on the face, back and chest, oedema and all the signs of puffiness characteristic of many users of steroids.
It can also cause high blood sugar levels, muscle weakness, and a greater susceptibility to infection.
All corticosteroids carry a number of additional risks, chiefly changes in the skin such as thinning, stretch marks, and dilation of the skin's blood vessels. They may cause birth defects if you are pregnant while using them.
You should take special precautions in using them if you have thrombosis, mental disorders, fungal infections, osteoporosis, ulcers, raised blood pressure or glaucoma, to name just a few conditions.
As you can see, your doctor has no business giving you this drug indefinitely. We suggest that you have him take a good look at the Data Sheet Compendium or that you speak to Glaxo themselves (they're in Greenford, Middlesex) to arm yourself with some ammunition before you next see your doctor.
One other bit of advice. If you decide to come off this drug, wean yourself off it slowly, over several weeks, and not all at once. Sudden withdrawal may provoke a life threatening reaction in your adrenal glands or a sudden fall in your blood pressure.