Drugs List

Therapeutic Indications

Uses

Dermatitis
Eczema
Psoriasis - scalp
Psoriasis excluding widespread plaque psoriasis

Contraindications

Children under 1 year
Nappy rash
Acne vulgaris
Genital pruritus
Perianal pruritus
Perioral dermatitis
Rosacea
Skin infection

Precautions and Warnings

Children under 18 years
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
May mask symptoms or signs of infections
Not all formulations are licensed for all uses
Avoid contact with eyes
Avoid occlusive dressings
Paediatric patients may be more susceptible to systemic toxicity
Corticosteroids may cause growth retardation in children under 18 years
Prolonged/excessive use may lead to adrenal suppression
Rebound effect may occur after cessation of treatment
Risk of generalised pustular psoriasis with use of topical corticosteroids
Withdraw gradually if adrenal suppression suspected
Discontinue if irritation or pain occurs
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

Topical corticosteroids may be hazardous to patients with psoriasis if tolerance to treatment develops as relapses could occur. There is also a risk of local systemic toxicity due to impaired barrier function of the skin. Careful patient supervision is important during treatment.

Hypothalamic pituitary adrenal (HPA) axis suppression can occur in patients using large doses of potent topical corticosteroids applied to large surface areas. These patients should be monitored periodically and if HPA axis suppression should occur, gradually withdraw the drug, reduce the frequency of application or substitute to a less potent corticosteroid.

Pregnancy and Lactation

Pregnancy

Use betamethasone dipropionate with caution in pregnancy.

At the time of writing there is limited published information regarding the topical use of corticosteroids during pregnancy. Briggs (2015) states that betamethasone crosses the placenta, however there is no evidence to suggest the topical use of corticosteroids increases the risk of teratogenic effects. The manufacturer suggests that topical steroids should only be used in pregnancy if the potential benefit to the mother outweighs the potential risk to the foetus.

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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use betamethasone dipropionate with caution in breastfeeding.

At the time of writing there is limited published information regarding the topical use of corticosteroids during breastfeeding. Hale (2015) states that betamethasone dipropionate should be used with caution on large areas and should not be used on the nipple area. Shaefer (2015) states that betamethasone is not the drug of choice when administrating systemic corticosteroids. The molecular weight of betamethasone is low enough that drug excretion in the breast milk is expected (Briggs et al, 2015), however the quantities excreted is unlikely to cause harm to the infant. The manufacturer suggests to discontinue the drug whilst breastfeeding, evaluating the potential risks to the mother if discontinuing treatment.

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 https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne-like eruptions
Adrenal suppression
Allergic contact dermatitis
Atrophy (localised)
Burning sensation (local)
Cushing's syndrome
Dry skin
Folliculitis
Hypertrichosis
Hypopigmentation
Irritation (localised)
Itching sensation (local)
Maceration of skin
Miliaria
Perioral dermatitis
Secondary infections
Striae
Superficial vascular dilation
Telangiectasia
Thinning of skin

Presentation

Topical formulations of betamethasone dipropionate

Drugs List

Therapeutic Indications

Uses

Dermatitis
Eczema
Psoriasis - scalp
Psoriasis excluding widespread plaque psoriasis

Dosage

Apply a thin layer once to twice daily to the affected area.

Additional Dosage Information

Contraindications

Children under 1 year
Nappy rash
Acne vulgaris
Genital pruritus
Perianal pruritus
Perioral dermatitis
Rosacea
Skin infection

Precautions and Warnings

Children under 18 years
Breastfeeding
Pregnancy

Careful supervision of patients with psoriasis required
May mask symptoms or signs of infections
Not all formulations are licensed for all uses
Avoid contact with eyes
Avoid occlusive dressings
Paediatric patients may be more susceptible to systemic toxicity
Corticosteroids may cause growth retardation in children under 18 years
Prolonged/excessive use may lead to adrenal suppression
Rebound effect may occur after cessation of treatment
Risk of generalised pustular psoriasis with use of topical corticosteroids
Withdraw gradually if adrenal suppression suspected
Discontinue if irritation or pain occurs
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

Topical corticosteroids may be hazardous to patients with psoriasis if tolerance to treatment develops as relapses could occur. There is also a risk of local systemic toxicity due to impaired barrier function of the skin. Careful patient supervision is important during treatment.

Hypothalamic pituitary adrenal (HPA) axis suppression can occur in patients using large doses of potent topical corticosteroids applied to large surface areas. These patients should be monitored periodically and if HPA axis suppression should occur, gradually withdraw the drug, reduce the frequency of application or substitute to a less potent corticosteroid.

Pregnancy and Lactation

Pregnancy

Use betamethasone dipropionate with caution in pregnancy.

At the time of writing there is limited published information regarding the topical use of corticosteroids during pregnancy. Briggs (2015) states that betamethasone crosses the placenta, however there is no evidence to suggest the topical use of corticosteroids increases the risk of teratogenic effects. The manufacturer suggests that topical steroids should only be used in pregnancy if the potential benefit to the mother outweighs the potential risk to the foetus.

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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use betamethasone dipropionate with caution in breastfeeding.

At the time of writing there is limited published information regarding the topical use of corticosteroids during breastfeeding. Hale (2015) states that betamethasone dipropionate should be used with caution on large areas and should not be used on the nipple area. Shaefer (2015) states that betamethasone is not the drug of choice when administrating systemic corticosteroids. The molecular weight of betamethasone is low enough that drug excretion in the breast milk is expected (Briggs et al, 2015), however the quantities excreted is unlikely to cause harm to the infant. The manufacturer suggests to discontinue the drug whilst breastfeeding, evaluating the potential risks to the mother if discontinuing treatment.

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 https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acne-like eruptions
Adrenal suppression
Allergic contact dermatitis
Atrophy (localised)
Burning sensation (local)
Cushing's syndrome
Dry skin
Folliculitis
Hypertrichosis
Hypopigmentation
Irritation (localised)
Itching sensation (local)
Maceration of skin
Miliaria
Perioral dermatitis
Secondary infections
Striae
Superficial vascular dilation
Telangiectasia
Thinning of skin

Overdosage

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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 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 (online) London: BMJ Group and Pharmaceutical Press. Accessed on 09 January 2017.

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

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Accessed on 09 January 2017.

Summary of Product Characteristics: Diprosone Cream. Merck Sharp & Dohme Limited. Revised July 2016.

Summary of Product Characteristics: Diprosone Lotion. Merck Sharp & Dohme Limited. Revised July 2016.

Summary of Product Characteristics: Diprosone Ointment. Merck Sharp & Dohme Limited. Revised July 2016.