betamethasone dipropionate + clotrimazole: clinical use

Prescribing considerations

• Confirm a susceptible fungal diagnosis and clinical need for the corticosteroid component.
• Avoid unnecessary exposure over large areas, damaged skin, flexures or under occlusion.
• Facial use, psoriasis or use in children requires particular caution and review.
• Consider infection, contact allergy or another diagnosis if the condition worsens or fails to respond.

Contraindications and cautions

• Hypersensitivity to any component, another corticosteroid or an imidazole
• Facial rosacea, acne vulgaris, perioral dermatitis or napkin eruption
• Bacterial or viral skin infection
• Occlusive or adhesive dressings

Monitoring

• Clinical response, secondary infection and sensitisation
• Skin atrophy, striae, pigment change, folliculitis and other local corticosteroid effects
• Systemic corticosteroid effects when absorption risk is increased
• Growth and endocrine effects if exceptionally used in children
• Visual symptoms; consider ophthalmology assessment

Clinical pharmacology

Clotrimazole inhibits ergosterol synthesis and disrupts fungal membrane function. Betamethasone dipropionate has glucocorticoid anti-inflammatory, antipruritic and vasoconstrictive effects. Clotrimazole has little systemic absorption through skin; corticosteroid absorption varies with vehicle, skin integrity and occlusion.

Formulation and product differences

• The product is a smooth white to off-white cream for cutaneous use.
• Cetostearyl alcohol may cause contact dermatitis; propylene glycol may irritate skin; benzyl alcohol may cause allergy or mild local irritation.
• The cream contains paraffin-based excipients and must not be used in the eyes.