betamethasone dipropionate: clinical use

Prescribing considerations

• Absorption increases through inflamed or damaged skin, skin folds, large treated areas and occlusion.
• Children have greater systemic exposure relative to body mass and are more susceptible to HPA-axis suppression and growth effects.
• Psoriasis requires careful supervision because of rebound, pustular psoriasis and systemic-toxicity risks.
• Investigate visual disturbance and consider ophthalmology referral.

Contraindications and cautions

• Hypersensitivity to the active ingredient or formulation excipients
• Rosacea, acne, perioral dermatitis, perianal or genital pruritus
• Tuberculous or most viral skin lesions, including herpes simplex and varicella
• Napkin eruption
• Untreated fungal or bacterial skin infection

Monitoring

• Review response and reassess worsening, irritation or suspected infection.
• Monitor for skin atrophy, striae, telangiectasia and withdrawal reactions during repeated or prolonged exposure.
• Consider HPA-axis assessment when substantial systemic absorption is plausible.
• Monitor children for growth, weight gain and signs of adrenal suppression or intracranial hypertension.

Clinical pharmacology

A fluorinated glucocorticoid with potent topical anti-inflammatory, antipruritic and vasoconstrictor activity. Percutaneous absorption depends on the vehicle and skin-barrier integrity; absorbed corticosteroid is principally metabolised in the liver and excreted through the kidneys.

Formulation and product differences

• Cream: an aqueous paraffin-based emulsion particularly suited to moist or weeping surfaces; contains chlorocresol and cetostearyl alcohol.
• Ointment: liquid paraffin and white soft paraffin base, generally suited to dry, thickened or scaly lesions.
• Lotion: a colourless scalp preparation containing carbomer, isopropyl alcohol, sodium hydroxide and purified water.
• All selected formulations can increase fabric flammability.