Betamethasone valerate topical
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Topical formulations containing betamethasone valerate.
Drugs List
Therapeutic Indications
Uses
Non-infected severe skin conditions responsive to corticosteroids
Non-infected severe skin conditions including:
Eczema (atopic and discoid eczemas)
Prurigo nodularis
Psoriasis (excluding widespread plaque psoriasis)
Lichen simplex chronicus (neurodermatoses) and lichen planus
Seborrhoeic dermatitis
Contact sensitivity reactions
Discoid lupus erythematosus
Adjunct to systemic steroid therapy in generalised erythroderma
Dosage
For specific dosage information see product information.
Betamethasone 0.025% cream and ointment is indicated for maintenance treatment when control has been achieved with betamethasone 0.1% preparations.
Apply a small amount of the betamethasone 0.1% w/w cream, ointment or lotion to the affected area once to three times a day.
It may be possible to maintain improvement by applying once a day or less often, or by using the more dilute betamethasone 0.025% w/w preparations.
Additional Dosage Information
In more resistant lesions, such as thickened plaques of psoriasis on elbows and knees, the effect of betamethasone preparations can be enhanced by occluding the treatment area with polythene film.
Overnight occlusion only is usually adequate to bring about a satisfactory response in such lesions, thereafter improvement can usually be maintained by regular application without occlusion.
Betamethasone cream is often appropriate for moist or weeping surfaces, and the ointment is often appropriate for dry, lichenified or scaly lesions, however this is not invariably so. The lotion is particularly suitable for treatment of hairy areas or when a minimal application to a large area is required.
Contraindications
Children under 1 year
Acne vulgaris
Perioral dermatitis
Rosacea
Skin infection
Precautions and Warnings
Children under 18 years
Breastfeeding
Genital pruritus
Perianal pruritus
Pregnancy
Careful supervision of patients with psoriasis required
Use appropriate antimicrobial therapy in infected lesions
Some formulations contain cetostearyl alcohol
Avoid application to broken skin
Avoid occlusive dressings in children
Avoid use in or near eyes
Breastfeeding: Wash product off breasts prior to breastfeeding infant
Cleanse skin thoroughly before applying occlusive dressings
Risk of glaucoma if preparation enters eye
If visual disturbances occur, perform ophthalmic evaluation
Adrenal suppression can occur in infants even without occlusion
Prolonged use may cause atrophic skin changes
Risk of generalised pustular psoriasis with use of topical corticosteroids
Some formulations contain chlorocresol, may cause allergic reactions
Withdraw gradually after long-term use
Withdraw gradually if adrenal suppression suspected
Discontinue if hypersensitivity reactions occur
Discontinue therapy and use antimicrobials if secondary infection occurs
Avoid long-term use particularly in infants and children
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
Nappy may act as an occlusive dressing
Long term continuous therapy should be avoided where possible, particularly in infants and children because adrenal suppression, with or without clinical features of Cushing's syndrome and reversible hypothalamic pituitary adrenal (HPA) axis suppression, can occur even without occlusion. In such occasions, treatment should be withdrawn gradually under medical supervision due to the risk of adrenal insufficiency.
Facial areas are more likely to exhibit atrophic changes after prolonged treatment with potent topical corticosteroids more than other body areas, limit the duration of treatment and do not use occlusion when applying treatment to the face.
Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses, development of tolerance and development of local or systemic toxicity due to impaired barrier function of the skin.
Pregnancy and Lactation
Pregnancy
Use topical betamethasone valerate with caution during pregnancy.
The manufacturer advises that topical betamethasone valerate is not used during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus and the minimum quantity is used for the minimum duration. Animal studies have shown abnormalities of foetal development, including cleft palate and intrauterine growth retardation. At the time of writing there is limited human data available. Risks are unknown.
Lactation
Use topical betamethasone valerate with caution during breastfeeding.
The manufacturer advises that topical betamethasone valerate is not used during breastfeeding unless the potential benefit to the mother outweighs the potential risk to the breastfed infant. There is limited published information regarding the use of topical betamethasone valerate in breastfeeding and it is not known if applied topical corticosteroids can result in sufficient systemic absorption to produce detectable amounts in breast milk. If this medication is used during breastfeeding, it should not be applied to the breasts, avoiding accidental ingestion by the infant.
Side Effects
Allergic contact dermatitis
Alopecia
Blurred vision
Burning sensation (local)
Cataracts
Central serous chorioretinopathy
Cushing's syndrome
Cushingoid changes
Dry skin
Erythema
Exacerbation of psoriasis
Exacerbation of symptoms
Glaucoma
Glucosuria
Hyperglycaemia
Hypersensitivity reactions
Hypertension
Hypertrichosis
Local atrophic changes
Opportunistic infections
Osteoporosis
Pruritus
Pustular psoriasis
Rash
Reduction in serum cortisol levels
Skin irritation
Skin pain
Skin pigmentation changes
Skin wrinkling
Striae
Suppression of growth in children and adolescents
Suppression of the hypothalamic-pituitary-adrenal axis
Telangiectasia
Thinning of skin
Trichorrhexis nodosa
Weight gain
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 2020
Reference Sources
Summary of Product Characteristics: Audavate Cream 0.1%. Accord UK Ltd. Revised August 2019.
Summary of Product Characteristics: Audavate Ointment 0.1%. Auden McKenzie. Revised August 2019.
Summary of Product Characteristics: Audavate RD Cream 0.025%. Auden McKenzie. Revised August 2019.
Summary of Product Characteristics: Audavate RD Ointment 0.025%. Auden McKenzie. Revised August 2019.
Summary of Product Characteristics: Betnovate Cream. GlaxoSmithKline UK. Revised October 2019.
Summary of Product Characteristics: Betnovate Ointment. GlaxoSmithKline UK. Revised October 2019.
Summary of Product Characteristics: Betnovate Lotion. GlaxoSmithKline UK. Revised October 2019.
Summary of Product Characteristics: Betnovate RD Cream. GlaxoSmithKline UK. Revised October 2019.
Summary of Product Characteristics: Betnovate RD Ointment. GlaxoSmithKline UK. Revised October 2019.
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