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Betamethasone dipropionate & salicylic acid topical


Topical formulations of betamethasone dipropionate and salicylic acid

Drugs List

  • betamethasone dipropionate 0.05% and salicylic acid 2% lotion
  • betamethasone dipropionate 0.05% and salicylic acid 3% ointment
  • DIPROSALIC ointment
  • DIPROSALIC scalp application
  • Therapeutic Indications


    Hyperkeratotic and dry dermatoses
    Psoriasis excluding widespread plaque psoriasis


    Apply a thin layer once or twice daily.

    The maximum weekly dose should not exceed 60 g. It is recommended that the treatment should be reviewed after two weeks.


    Nappy rash
    Acne vulgaris
    Genital pruritus
    Perianal pruritus
    Perioral dermatitis
    Skin infection

    Precautions and Warnings

    Children under 18 years

    Careful supervision of patients with psoriasis required
    Treat and control infections prior to commencing therapy
    Avoid contact with eyes
    Avoid contact with mucous membranes
    Avoid occlusive dressings
    May cause local and systemic toxicity especially in prolonged/extensive use
    Paediatric patients may be more susceptible to systemic toxicity
    Corticosteroids may cause growth retardation in children under 18 years
    Prolonged use may cause atrophic skin changes
    Prolonged/excessive use may lead to adrenal suppression
    Risk of generalised pustular psoriasis with use of topical corticosteroids
    Tolerance may develop with continued use
    Discontinue if irritation or sensitisation occur
    Avoid long term continuous therapy
    Limit use in children to 5 days
    Limit use on face to 5 days
    Advise patient residue on clothing/bedding may cause fire hazard
    Fire hazard: Keep away from naked flames and potential sources of ignition

    Children may have a greater susceptibility to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression due to a larger skin surface area to body weight ratio meaning a greater chance of absorption.

    Supervision is required if used in psoriasis as topical corticosteroids have the potential to be hazardous inlcuding rebound relapses following development of tolerance, risk of pustular psoriasis and developments of local and systemic toxicity due to impaired barrier function of the skin.

    Pregnancy and Lactation


    Use betamethasone dipropionate and salicylic acid with caution in pregnancy.

    At the time of writing there is limited published information regarding the use of systemic corticosteroids associated with the increased risk of congenital abnormalities in human pregnancy. Briggs (2015) states the use of corticosteroids during the first trimester have been associated with the increased risk of developing a cleft palate, however betamethasone has not been specifically identified in any studies. Corticosteroids should only be used during pregnancy if the potential benefit to the mother outweighs any potential risk to the foetus.

    Salicylates have not shown any systemic effects when used appropriately during pregnancy (Schaefer et al, 2015).

    The manufacturer suggests to avoid using betamethasone dipropionate with salicylic acid in large amounts or over a long period of time in pregnancy.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use betamethasone dipropionate and salicylic acid with caution in breastfeeding.

    It is not known whether systemic absorption of topical corticosteroids is detectable in breast milk, however the molecular weight of betamethasone dipropionate suggests it is low enough to be excreted in breast milk (Briggs et al, 2015). Hale (2014) categorises betamethasone dipropionate as high potency stating to use with caution and avoid application to the nipple area.

    Salicylic acid is well absorbed however Hale (2014) states there is no published information suggesting it can be found excreted in breast milk (Hale et al, 2014). Briggs (2015) states salicylates are excreted in breast milk in low concentrations that increases the risk of adverse effects on platelet function.

    The manufacturer suggests to discontinue breastfeeding if using betamethasone dipropionate with salicylic acid.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Acne (at application site)
    Acne-like eruptions
    Allergic contact dermatitis
    Burning sensation (local)
    Cushing's syndrome
    Exacerbation of infection
    Growth retardation (children)
    Hypersensitivity reactions
    Intracranial hypertension
    Irritation (localised)
    Itching sensation (local)
    Local atrophic changes
    Perioral dermatitis
    Pustular psoriasis
    Secondary infections
    Skin atrophy
    Striae (irreversible)
    Superficial vascular dilation
    Suppression of the hypothalamic-pituitary-adrenal axis
    Thinning of skin
    Weight gain


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last full Review Date: March 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Joint Formulary Committee. British National Formulary. 72nd ed. London: BMJ Group and Pharmaceutical Press; 2016.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Paediatric Formulary Committee. BNF for Children 2016-2017. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2016.

    Summary of Product Characteristics: Diprosalic Scalp Application. Merk Sharp & Dohme Ltd. Revised March 2015.

    Summary of Product Characteristics: Diprosalic Ointment. Merk Sharp & Dohme Ltd. Revised July 2015.

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