betamethasone valerate + neomycin: clinical use

Prescribing considerations

• Reserve for corticosteroid-responsive dermatoses where secondary bacterial infection is present, suspected or likely.
• Reassess persistent or spreading infection; corticosteroid activity can mask extension.
• Absorption increases on inflamed or damaged skin, large areas, the face, flexures or beneath occlusion.
• Children are proportionally more susceptible to systemic corticosteroid effects.
• Consider renal function if clinically significant neomycin absorption is possible.
• Extended or recurrent exposure increases neomycin contact-sensitisation risk.
• Psoriasis requires careful supervision because of rebound, pustular psoriasis and systemic absorption risks.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Rosacea, acne vulgaris or perioral dermatitis
• Itching without inflammation, including perianal or genital itching
• Primary viral skin infection
• Primary fungal or bacterial lesions, yeast infection, or secondary infection due to Pseudomonas or Proteus
• Dermatoses in children younger than 2 years, including napkin eruptions
• Otitis externa with a perforated tympanic membrane
• Use likely to cause substantial neomycin absorption over large areas or prolonged exposure

Monitoring

• Clinical response and persistent or spreading infection
• Local irritation, allergic contact dermatitis and extension beyond the treated area
• Skin atrophy, telangiectasia, striae or pigment change
• HPA-axis suppression or Cushingoid effects when absorption risk is increased
• Growth and weight gain in children if systemic exposure is suspected
• Visual symptoms, with ophthalmology assessment where indicated
• Renal function, hearing and neuromuscular function if substantial neomycin absorption is suspected
• Rebound redness, burning, peeling or oozing after inappropriate or prolonged exposure

Clinical pharmacology

Betamethasone valerate is a potent topical glucocorticoid that suppresses inflammatory dermatoses. Neomycin is a broad-spectrum bactericidal aminoglycoside. Absorption increases with impaired skin-barrier integrity and occlusion; significant systemic neomycin exposure carries nephrotoxic and irreversible ototoxic potential.

Formulation and product differences

• Aqueous cream generally suits moist or weeping surfaces.
• Ointment generally suits dry, lichenified or scaly lesions.
• Cream contains chlorocresol, which may cause allergic reactions, and cetostearyl alcohol, which may cause local contact dermatitis.
• Ointment contains liquid paraffin and white soft paraffin.
• Neither formulation should be diluted.

Cream

Route: Cutaneous

Strengths: 1 mg + 5 mg/g

Ointment

Route: Cutaneous

Strengths: 1 mg + 5 mg/g