When treating individuals with steroid-responsive dermatosis or plaque psoriasis, halobetasol propionate (Bryhali) lotion is thought of as an extremely strong topical corticosteroid.

Halobetasol Propionate (Bryhali) Uses:

• Steroid-responsive dermatoses (cream and ointment):

  • It alleviates the inflammatory and itchy symptoms of dermatoses with a corticosteroid response. It is regarded as a very strong steroid.

  Plaque psoriasis (foam, lotion):

  • Patients who are at least 18 years old can take it to treat their plaque psoriasis.

Halobetasol Propionate (Bryhali) Dose in Adults

Dose in the treatment of Plaque psoriasis: Topical:

• Lotion 0.01%:
  • Once daily for up to 8 weeks, the patient should apply a thin layer to the affected skin.
  • The weekly dose shouldn't be greater than 50 g.
  • When control is attained, therapy should be halted.
  • However, a new diagnosis must be made if there is no improvement after 8 weeks.
• Foam, lotion 0.05%:
  • It should be applied twice daily for up to 14 days in a thin layer to the afflicted skin.
  • The weekly dose shouldn't be greater than 50 g.
  • When control is attained, therapy should be halted.
  • The diagnosis needs to be reevaluated if no improvement is noticed in 10–14 days.

Dose in the treatment of Steroid-responsive dermatoses:

• Cream and Ointment: Topical:
  • Apply sparingly once or twice daily to the skin
  • The course of treatment should not last longer than two weeks, and the maximum weekly dosage is 50 g.
  • When control is attained, stop the therapy; if there is no improvement after two weeks, the diagnosis may need to be reevaluated.

Halobetasol Propionate (Bryhali) Dose in Childrens

Dose in the treatment of Plaque psoriasis:

• Adolescents ≥18 years:

  • Topical Lotion:
    • For up to two weeks, apply lotion in a thin layer twice daily to the affected skin.
    • No more than 50 g may be taken overall every week.
    • When you feel in control, stop counselling. After 14 days, if there has been no improvement, the diagnosis should be reevaluated.

Halobetasol Propionate (Bryhali) Dose in the treatment of Steroid-responsive dermatoses:

• Children ≥12 years and Adolescents:

  • Topical Cream, Ointment:
    • Treatment for greater than 14 days is not recommended.
    • It is notable that to decrease the risk of systemic effects, only treat small areas at any one time. Stop therapy when control is achieved.
    • Apply cautiously once or twice a day.
    • The maximum dose allowed is 50 g/week.

Halobetasol Propionate Pregnancy Category: C

• The bioavailability and integrity of topical steroids are both variables. 
• The trimester in which you are pregnant can have an impact on the bioavailability of topical steroids.
• As shown in the trial, there have been no adverse pregnancy outcomes from topical corticosteroids.
• High doses of topical creams can increase the risk of low birth weight babies.
• Topical steroids should not be used in large quantities or for long periods.
• These areas should not be used if maximum skin absorption is possible.
• Patients who have used topical steroids are more likely to develop stretch marks.
• Psoriasis can be treated in pregnancy just like in non-pregnant women.
• Low to moderate potency corticosteroids can be recommended when a topical steroid needs to be used.
• Only pregnant women should be given potent steroids if they are clinically necessary.

Halobetasol use during breastfeeding:

• Systemic steroids are found in breast milk.
• It is better to select whether or not to give birth to steroids in nursing mothers if the advantages outweigh any hazards.
• For the treatment of psoriasis, it is preferable to use low-to-moderate-potency topical corticosteroids in breastfeeding women.
• You should not apply any topical corticosteroids at the breast until you stop breastfeeding; hypertension has been reported in breastfed infants who were given high-potency topical steroids to their nipples.

Dose in Kidney disease:

In chronic kidney disease, there is no need to change the dosage.

Dose in Liver disease:

In chronic liver disease, there is no need to change the dosage.

Common Side Effects of Halobetasol Propionate (Bryhali):

• Endocrine & metabolic:

  • HPA-axis suppression

Less Common Side Effects of Halobetasol Propionate (Bryhali):

• Central Nervous System:

  • Headache

• Dermatologic:

  • Stinging Of The Skin
  • Telangiectasia

• Endocrine & Metabolic:

  • Hyperglycemia

• Local:

  • Application Site Atrophy
  • Application Site Burning
  • Application Site Pruritus
  • Application Site Dermatitis

• Respiratory:

  • Upper Respiratory Tract Infection

Side effects of Halobetasol Propionate (Bryhali) Frequency Not Defined:

• Central Nervous System:

  • Paresthesia

• Dermatologic:

  • Acne Vulgaris
  • Leukoderma
  • Local Dryness
  • Miliaria
  • Pustules
  • Secondary Skin Infection
  • Urticaria

• Local:

  • Application Site Rash
  • Application Site Erythema
  • Application Site Vesicles

Contraindications to Halobetasol Propionate (Bryhali):

• Halobetasol should be stopped if hypersensitivity develops.

Foam and lotion

• The manufacturer does not provide any contraindications.

Additional contraindications not included on Canadian labels

• Cream and ointment
  • Untreated bacterial, tubercular, and fungal skin diseases.
  • This includes viral illnesses like chickenpox and herpes simplex.
• There is not much evidence of cross-reactivity between corticosteroids and allergenic corticosteroids. 
• Cross-sensitivity cannot always be ruled out because of comparable biochemical characteristics.

Cautions and Alerts

• Suppression of the adrenals:

  • For example, it can lead to hypercortisolism or suppress the hypothalamic-pituitary-adrenal (HPA) axis in patients receiving large doses for extended periods of time or in younger people.
  • The HPA axis can become suppressed, which can result in an adrenal crisis.

• Contact dermatitis:

  • It's possible to get allergy contact dermatitis. Instead of clinical aggravation, the failure of healing is frequently used to diagnose it. Stop therapy if contact dermatitis develops.

• Kaposi Sarcoma:

  • Kaposi Sarcoma has been linked to prolonged treatment with potent steroids, according to several case reports.
  •  It is important to stop taking potent steroids if you are experiencing symptoms.

• Local effects

  • Atrophy, striae, and telangiectasias of the skin are examples of local responses. These responses might not be reversible.
  • Severe adverse reactions can be observed when corticosteroids are used in higher doses or occlusive dressings.
  • Stop using the product if you experience any skin irritations.

• Ocular effects

  • Topical steroids can increase the likelihood of developing posterior subcapsular cataracts or glaucoma. Pay attention to any ocular symptoms. Avoid eye contact.

• Skin infections

  • To treat skin infections that are concomitant, use the appropriate antibacterial and antifungal medications. If the infection persists, discontinue treatment.

• Systemic effects

  • Percutaneous absorption of topical corticosteroids is possible.
  • The absorption of topical corticosteroids can lead to Cushing's syndrome, hyperglycemia or glycosuria.
  • Absorption can be boosted by applying to skin that is dehydrated or using occlusive dressings.

Monitoring parameters:

• Expansion in young patients.
• Symptoms of adrenal insufficiency and/or inhibition of the HPA axis.
• Monitoring skin infections caused by bacteria or fungi is necessary.

How to administer Halobetasol Propionate (Bryhali)?

Topical: 

• It is recommended for external use only.
• It cannot be used for ophthalmic, oral, or intravaginal use.
• Applying to the face, groyne, axillae, or scalp is not advised.
• Occlusive dressings shouldn't be used unless prescribed by a medical professional.
• Apply a little layer to the affected region, then gently and thoroughly rub it in.
• Wash hands after application.

Mechanism of action of Halobetasol Propionate (Bryhali):

• The anti-inflammatory, anti-pruritic, and vasoconstrictive properties of topical corticosteroids.
• Through the activation and inhibition of sequential arachidonic acid release and phospholipase A2 inhibitory protein, it can reduce the generation, release, and activity of endogenous chemical mediators (kinins and histamines) (lipocortins). The name of the highly effective topical corticosteroid is Halobetasol.

Metabolism:

• Primarily hepatic

Excretion:

• Urine

Absorption:

• The formulation, the use of occlusive dressings, and epidermal integrity (abraded skin vs. intact skin) all affect percutaneous absorption.
• Within 96 hours, 6% of dosages given topically enter the bloodstream.

International Brand Names of Halobetasol:

• Bryhali
• Halac
• Halobetasol Propionate
• Lexette
• Ultravate
• Halobex
• Tabitral

Halobetasol Brand Names in Pakistan:

No Brands Available in Pakistan.