betamethasone + calcipotriol: clinical use

Prescribing considerations

• Confirm stable plaque psoriasis and exclude infection or alternative diagnoses.
• Avoid the face, genital skin, mucosae, skin folds, damaged skin and occlusion.
• Review concurrent topical steroids, calcipotriol products, systemic antipsoriatic treatment and phototherapy.
• Safety and efficacy are not established for people under 18 or adequately evaluated in severe renal or hepatic impairment.
• Continued or repeated use requires medical review because prolonged corticosteroid exposure increases local and systemic risk.

Contraindications and cautions

• Hypersensitivity to either active ingredient or an excipient
• Erythrodermic, exfoliative or pustular psoriasis
• Known disorders of calcium metabolism
• Untreated bacterial, fungal, viral or parasitic skin infection
• Tuberculous skin lesions, perioral dermatitis, rosacea, acne, atrophic skin, ichthyosis, ulcers or wounds

Monitoring

• Assess response, local atrophy, infection and rebound or pustular worsening.
• Consider calcium assessment after excessive exposure or if hypercalcaemia symptoms develop.
• Consider systemic corticosteroid effects with extensive exposure, damaged skin or occlusion; monitor diabetic control where relevant.
• Investigate blurred vision or other visual disturbance and consider ophthalmology referral.

Clinical pharmacology

Calcipotriol regulates keratinocyte differentiation and proliferation. Betamethasone dipropionate has potent anti-inflammatory, antipruritic, vasoconstrictive and immunosuppressive activity. Systemic absorption from intact skin is low but rises with damaged skin, occlusion and extensive application.

Formulation and product differences

• The selected product is an off-white ointment with a paraffin-rich vehicle.
• Ointment is greasy and may suit dry, scaly plaques, but can stain textiles.
• Instructions and licensed treatment sites should not be assumed to match gel, foam or cream formulations.

Ointment

Route: Cutaneous

Strengths: 50 micrograms/g + 0.5 mg/g