betamethasone dipropionate + salicylic acid: clinical use

Prescribing considerations

• Confirm a corticosteroid-responsive, hyperkeratotic dermatosis and choose the formulation for the anatomical site.
• Reassess deterioration, treatment failure or rapid recurrence after withdrawal.
• Use particular caution on the face, flexures, damaged skin, extensive areas and in children because absorption is increased.
• Supervise psoriasis because of rebound, pustular transformation and systemic-toxicity risks.
• Counsel about ocular avoidance, withdrawal reactions and the fabric fire hazard.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient.
• Rosacea, acne, perioral dermatitis, perianal or genital pruritus and napkin eruptions.
• Tuberculous or most viral skin lesions, including herpes simplex and varicella.
• Fungal or bacterial skin infection without suitable anti-infective treatment.
• Occlusive dressings.

Monitoring

• Clinical response, irritation, sensitisation, infection and skin atrophy.
• Visual symptoms, with ophthalmology assessment where indicated.
• Adrenal suppression or corticosteroid excess when absorption risk is increased.
• Growth and weight gain in children receiving substantial exposure.
• Rebound erythema, burning or pustulation after withdrawal.

Clinical pharmacology

Betamethasone dipropionate is a potent glucocorticoid with anti-inflammatory, antipruritic and vasoconstrictive effects. Salicylic acid is keratolytic and facilitates corticosteroid penetration through thickened scale. Absorption rises with inflammation, damaged skin, large treated areas, skin folds and occlusion.

Formulation and product differences

• The ointment is a white, semitransparent paraffin-based preparation for dry, thickened skin.
• The scalp application is a colourless, viscous, alcohol-containing cutaneous solution intended only for the scalp.
• The formulations differ in salicylic-acid strength and excipients.

Ointment

Route: Cutaneous

Strengths: 0.05% w/w + 3% w/w