Introduction
Impoyz (clobetasol propionate) cream 0.025% is a high-potency topical corticosteroid approved by the FDA for the treatment of plaque psoriasis in patients 18 years and older. This synthetic corticosteroid is specifically formulated for limited duration use in managing inflammatory and pruritic manifestations of this chronic skin condition.
Mechanism of Action
Clobetasol propionate, the active ingredient in Impoyz, exerts its pharmacological effects through binding to cytoplasmic glucocorticoid receptors. This drug-receptor complex translocates to the cell nucleus where it binds to glucocorticoid response elements in DNA, resulting in:
- Modulation of gene transcription
- Inhibition of inflammatory mediator production (cytokines, chemokines, adhesion molecules)
- Suppression of lymphocyte proliferation and migration
- Vasoconstrictive effects that reduce erythema and edema
- Antiproliferative effects on keratinocytes
The net effect is reduction of inflammation, itching, and scaling associated with psoriatic lesions.
Indications
- Treatment of moderate to severe plaque psoriasis in adults
- Management of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses
Dosage and Administration
Standard dosing: Apply a thin layer to affected areas twice daily for up to 2 weeks Maximum weekly dose: Do not exceed 50 g per week Application instructions: Gently rub into affected areas until cream disappears Treatment duration: Limited to 2 consecutive weeks Treatment course: Do not repeat course without medical supervision Special populations:- Geriatric patients: Use with caution due to increased skin atrophy risk
- Hepatic impairment: No specific dosage adjustment recommended
- Renal impairment: No specific dosage adjustment recommended
- Pediatric patients: Not recommended for patients under 18 years
Pharmacokinetics
Absorption: Topical absorption varies based on skin integrity, application site, and use of occlusive dressings. Systemic absorption increases with application to inflamed skin, large surface areas, or prolonged use. Distribution: Highly lipophilic, distributes widely throughout body tissues. Binds extensively to plasma proteins (approximately 99%). Metabolism: Primarily hepatic metabolism via CYP3A4 to inactive metabolites. Elimination: Renal excretion of metabolites (approximately 40-50%) and fecal elimination (approximately 30-40%). Half-life approximately 5-6 hours.Contraindications
- Hypersensitivity to clobetasol propionate or any component of the formulation
- Use on rosacea, perioral dermatitis, or acne vulgaris
- Application to face, groin, or axillae unless directed by physician
- Use in children under 18 years of age
- Presence of cutaneous infections unless appropriate antimicrobial therapy is concurrently administered
Warnings and Precautions
HPA axis suppression: May cause reversible hypothalamic-pituitary-adrenal (HPA) axis suppression with potential for glucocorticoid insufficiency after treatment withdrawal. Skin reactions: May produce local adverse reactions including atrophy, striae, telangiectasias, contact dermatitis, and hypopigmentation. Occlusive therapy: Do not use occlusive dressings unless directed by physician. Systemic effects: Prolonged use may result in systemic corticosteroid effects including hyperglycemia, glucosuria, Cushing's syndrome, and adrenal suppression. Infection risk: Do not use in presence of skin infections. May mask symptoms of infection. Ophthalmic effects: May increase risk of glaucoma and cataracts if applied near eyes.Drug Interactions
No formal drug interaction studies conducted. However, theoretical interactions include:- Increased systemic absorption when used with other topical products that enhance percutaneous absorption
- Potential additive effects with other systemic or topical corticosteroids
- Possible interference with skin testing procedures
Adverse Effects
Common (≥1%):- Application site reactions (burning, itching, irritation)
- Dry skin
- Folliculitis
- Skin atrophy
- Striae
- HPA axis suppression
- Cushing's syndrome
- Hyperglycemia
- Vision changes (glaucoma, cataracts)
- Secondary skin infections
- Contact dermatitis
- Hypersensitivity reactions
Monitoring Parameters
- Clinical response and skin condition at application sites
- Signs of HPA axis suppression (fatigue, weakness, nausea, hypotension)
- Blood pressure and blood glucose in patients with diabetes
- Signs of skin infection or worsening dermatological condition
- Ophthalmic examination with prolonged use near eye area
- Pediatric growth monitoring if used off-label in children
Patient Education
- Use only as directed by healthcare provider for prescribed duration
- Apply thin layer only to affected areas
- Avoid contact with eyes, mouth, and mucous membranes
- Do not use on face, groin, or underarms unless specifically instructed
- Wash hands after application unless hands are treatment area
- Report any signs of local reactions (burning, itching, redness)
- Notify healthcare provider if condition worsens or doesn't improve after 2 weeks
- Do not cover treated area with tight dressings unless instructed
- Inform all healthcare providers about Impoyz use
- Store at room temperature, avoid freezing
References
1. FDA Prescribing Information: Impoyz (clobetasol propionate) Cream. 2018. 2. Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Elsevier; 2018. 3. Wolverton SE. Comprehensive Dermatologic Drug Therapy. 4th ed. Elsevier; 2020. 4. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology. 2011;65(1):137-174. 5. Katz HI, Hien NT, Prawer SE, et al. Superpotent topical steroid treatment of psoriasis vulgaris—clinical efficacy and adrenal function. Journal of the American Academy of Dermatology. 1987;16(4):804-811. 6. ClinicalTrials.gov: Phase 3 Study of Clobetasol Propionate Cream in Plaque Psoriasis. NCT01553058.