Betamethasone for skin

Generic Name

Betamethasone

Brand Names

Betnovate

Celestone Topical

Diprosone

Luxiq (foam)

Valisone

Numerous generic versions available as creams, ointments, lotions, gels, scalp applications, and foams

Drug Class

Topical corticosteroid

Medium to very potent (depending on formulation and concentration)

Anti-inflammatory, antipruritic, and vasoconstrictive dermatologic agent

Mechanism of Action

Betamethasone is a synthetic fluorinated corticosteroid that acts by suppressing the inflammatory response and the immune reaction in the skin

It binds to glucocorticoid receptors in skin cells and modulates transcription of anti-inflammatory proteins

Inhibits the release of pro-inflammatory cytokines, histamine, and arachidonic acid metabolites such as prostaglandins

Reduces redness, swelling, itching, and skin thickening

Vasoconstriction reduces capillary permeability, limiting further immune cell recruitment

Indications

Approved Dermatologic Uses

Eczema (atopic dermatitis, discoid eczema)

Contact dermatitis (irritant or allergic)

Seborrheic dermatitis

Psoriasis (excluding widespread plaque or pustular forms)

Lichen planus

Lichen simplex chronicus

Discoid lupus erythematosus (localized skin lesions)

Insect bites with intense inflammation

Pruritus due to inflammatory skin conditions

Intertrigo (mild formulations, sometimes in combination with antifungals)

Formulations and Potency Classification

Potency depends on formulation and vehicle

Low Potency

Betamethasone valerate 0.025% lotion or cream

Moderate Potency

Betamethasone valerate 0.1% cream or ointment

Betamethasone dipropionate 0.05% cream in certain emulsions

High Potency

Betamethasone dipropionate 0.05% ointment

Augmented betamethasone dipropionate gel or foam (enhanced penetration)

Betamethasone dipropionate in optimized vehicle or propylene glycol

Dosing and Application Instructions

Apply thinly to the affected skin areas once or twice daily depending on the formulation and clinical response

Rub in gently until the product disappears

Limit use to a maximum of 2–4 weeks continuously unless directed by a dermatologist

If improvement is seen, reduce frequency or switch to lower-potency steroid

Occlusive dressings (e.g., plastic wrap) may increase absorption and are used under specialist guidance only

Fingertip Unit (FTU) Guideline

One FTU (amount of cream from tip to first finger joint) = ~0.5 g

Adult hand: 1 FTU

Adult face and neck: 2.5 FTU

Adult one arm: 3 FTU

Adult one leg: 6 FTU

Adult trunk (front or back): 7 FTU

Contraindications

Untreated bacterial, viral, or fungal skin infections

Rosacea

Acne vulgaris

Perioral dermatitis

Hypersensitivity to betamethasone or formulation ingredients

Application on broken or ulcerated skin (unless directed)

Widespread use in infants, especially under nappies

Precautions

Avoid long-term continuous use, particularly on the face, genitals, or intertriginous areas

Use the lowest potency effective for the shortest duration

Avoid use around the eyes due to risk of glaucoma or cataract

Monitor skin for signs of thinning or atrophy in chronic use

Caution in children: skin more permeable, risk of systemic absorption higher

Do not use under occlusive dressings unless advised

Avoid abrupt withdrawal after long-term use in chronic conditions like psoriasis

Use antifungal or antibiotic combination products only under clear indication and for short periods

Adverse Effects

Local (Common with prolonged or inappropriate use)

Skin thinning (atrophy)

Striae (stretch marks)

Telangiectasia (visible small blood vessels)

Hypopigmentation

Perioral dermatitis

Acneiform eruptions

Delayed wound healing

Contact dermatitis (from excipients or steroid itself)

Burning, itching, stinging (especially at start of therapy)

Local (Less Common)

Folliculitis

Increased hair growth (hypertrichosis)

Secondary infection at site

Irritation or allergic rash

Systemic (Rare with topical but possible in overuse or high-potency agents)

Suppression of hypothalamic-pituitary-adrenal (HPA) axis

Cushing’s syndrome features (moon face, weight gain)

Hyperglycemia

Growth retardation in children

Glaucoma and cataract (if used near or on eyelids)

Pregnancy and Lactation

Pregnancy

Topical use is generally considered safe in pregnancy when used in short durations and at mild or moderate potency

Avoid prolonged high-potency use or large-area applications

Avoid occlusion

Lactation

Can be used during breastfeeding if applied away from the nipple

Ensure area is washed prior to feeding

Do not apply directly to breast unless under medical advice

Use in Special Populations

Children

Use low-potency preparations

Apply sparingly due to increased systemic absorption

Limit duration and area of use

Avoid nappy area unless prescribed

Elderly

Skin is thinner; more susceptible to atrophy

Use the lowest potency and shortest course possible

Face, Genitals, and Intertriginous Areas

Use low-potency only

Monitor closely for adverse effects

Drug Interactions

No significant systemic interactions due to limited absorption

Avoid concurrent use of other topical agents unless directed

If using moisturizers or emollients, apply steroid first and wait 30 minutes

Monitoring Parameters

Monitor skin for improvement and side effects (especially thinning, discoloration, or secondary infection)

In long-term use, monitor for systemic signs (weight gain, facial changes, fatigue)

Check intraocular pressure if used near eyes

In children, monitor growth and development

Monitor disease flare-ups upon withdrawal

Patient Counseling Points

Use a thin layer, only on affected areas

Do not apply more frequently than instructed

Do not use on face, groin, or armpits unless advised

Do not cover the area with dressings unless directed

Avoid getting into eyes, nose, or mouth

Wash hands after use unless hands are being treated

Do not share this medication with others

Inform your healthcare provider if condition worsens or does not improve in 2 weeks

Report any signs of skin thinning, stretch marks, or new rashes

Do not use on broken or infected skin unless prescribed in combination with antimicrobials

Store at room temperature, away from moisture and sunlight

Keep out of reach of children

Storage

Store between 15°C to 30°C depending on manufacturer instructions

Do not freeze

Keep the tube tightly closed after use