An investigator-initiated, double-blind, vehicle-controlled pilot study: assessment for tachyphylaxis to topically occluded halobetasol 0.05% ointment in the treatment of psoriasis

J Am Acad Dermatol. 2014 Nov;71(5):954-959.e1. doi: 10.1016/j.jaad.2014.05.040. Epub 2014 Jun 11.


Background: Topical corticosteroids are the most common first-line treatment for psoriasis. Tachyphylaxis, a decreased response to treatment with repetitive application of the drug, is a controversial phenomenon associated with topical corticosteroid treatment.

Objective: We sought to prove or disprove tachyphylaxis to occluded halobetasol 0.05% versus vehicle.

Methods: Patients with plaque psoriasis were recruited to this study. The study involved 3 phases (1, 2A, and 2B) with each phase being separated by a treatment vacation period. In phases 1 and 2A, 2 plaques were randomized to either halobetasol 0.05% or vehicle ointment application. In phase 2B, halobetasol 0.05% was applied to both. Target Lesion Severity Scale was used for clinical assessment.

Results: Twenty patients were enrolled. No difference in time to clearance (P=.88) or time to recurrence (P=.92) of the treated plaques was found between phases 1 and 2A. Percentage of improvement was higher in phase 2A compared with phase 1 (89.4%, P<.05 vs 71%, P<.05), as a result of reduction of vehicle effect. In phase 2B, a greater improvement was found for previously corticosteroid-treated plaques.

Limitations: Limitations are small sample size and 1 corticosteroid tested.

Conclusion: No evidence of tachyphylaxis to the topical corticosteroid halobetasol 0.05% ointment treatment in patients with plaque psoriasis was found.

Keywords: compliance; corticosteroid; halobetasol 0.05%; psoriasis; tachyphylaxis; vehicle.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Cutaneous
  • Adult
  • Clobetasol / administration & dosage
  • Clobetasol / analogs & derivatives*
  • Dermatologic Agents / administration & dosage*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Ointments / administration & dosage
  • Pilot Projects
  • Psoriasis / drug therapy*
  • Severity of Illness Index
  • Tachyphylaxis*
  • Young Adult


  • Dermatologic Agents
  • Ointments
  • halobetasol
  • Clobetasol