betamethasone valerate + clioquinol: clinical use

Prescribing considerations

• Confirm steroid-responsive inflammation with secondary bacterial or fungal infection present, suspected or likely.
• Reassess the diagnosis if there is no clinical improvement; corticosteroid activity may mask extension of infection.
• Avoid unnecessary occlusion and take particular care with facial, flexural, eyelid, extensive or damaged skin.
• Use in psoriasis requires close supervision because of rebound, pustular psoriasis and systemic-toxicity risks.
• Children absorb proportionally more topical corticosteroid and are more susceptible to systemic effects.
• Consider the fire risk from paraffin-containing residue on dressings, clothing and bedding.

Contraindications and cautions

• Hypersensitivity to either active ingredient or a formulation excipient
• Rosacea, acne vulgaris or perioral dermatitis
• Primary viral skin infections such as herpes simplex or chickenpox
• Primary untreated bacterial, fungal or yeast skin infection
• Perianal or genital itching without the indicated infected inflammatory dermatosis
• Dermatoses in children younger than 2 years

Monitoring

• Review for spreading or persistent infection and consider alternative or systemic anti-infective treatment when appropriate.
• Monitor for skin atrophy, contact allergy and steroid withdrawal reactions when exposure is prolonged or repeated.
• Consider HPA-axis effects when absorption may be substantial, including extensive, inflamed or occluded application.
• Monitor growth where clinically relevant in children with substantial exposure.
• Investigate blurred vision or other visual symptoms; cataract, glaucoma and central serous chorioretinopathy are possible considerations.

Clinical pharmacology

Betamethasone valerate provides potent glucocorticoid-mediated anti-inflammatory activity. Clioquinol has local antibacterial and anticandidal activity. Corticosteroid absorption rises when the epidermal barrier is impaired or the area is occluded.

Formulation and product differences

• Cream is generally more suitable for moist or weeping surfaces.
• Ointment is generally more suitable for dry, thickened or scaly lesions.
• The cream contains chlorocresol, which may cause allergic reactions, and cetostearyl alcohol, which may cause local contact dermatitis.
• The ointment has a paraffin-only base and does not contain the cream's chlorocresol or cetostearyl alcohol.

Cream

Route: Cutaneous

Strengths: 1 mg + 30 mg/g

Ointment

Route: Cutaneous

Strengths: 1 mg + 30 mg/g