betamethasone valerate: clinical use

Prescribing considerations

• Confirm that the condition is inflammatory and corticosteroid-responsive; reassess deterioration or non-response for infection, rosacea, perioral dermatitis, contact allergy or another diagnosis.
• Systemic exposure rises with larger treated areas, impaired skin barrier, thin skin, occlusion and more absorbent formulations.
• Use particular caution on the face, eyelids, flexures and genital skin.
• Children have proportionally greater absorption and susceptibility to adrenal suppression; product age restrictions differ.
• Psoriasis requires supervision because rebound, pustular psoriasis and systemic toxicity can occur.
• Consider topical steroid withdrawal when marked burning and confluent colour change extend beyond the treated area after stopping prolonged or inappropriate treatment.

Contraindications and cautions

• Hypersensitivity to betamethasone valerate or formulation excipients.
• Untreated cutaneous infection; Bettamousse specifically excludes bacterial, fungal, parasitic or viral scalp infection unless treated simultaneously.
• Rosacea, acne vulgaris, perioral dermatitis, non-inflammatory pruritus, and perianal or genital pruritus should not be treated with the selected cream, ointment or lotion products.
• Betnovate products are contraindicated for dermatoses in infants under 1 year; Bettamousse is contraindicated under 6 years.

Monitoring

• Review diagnosis and adherence if disease worsens or fails to respond.
• Check for skin atrophy, striae, telangiectasia, pigment change, contact allergy, secondary infection and withdrawal reactions.
• Assess for systemic corticosteroid effects when absorption risk is high; monitor growth where repeated or extensive treatment is necessary in children.
• Investigate blurred vision or other visual disturbance, with ophthalmology assessment where appropriate.
• Prolonged foam treatment requires clinical review and consideration of systemic activity.

Clinical pharmacology

Betamethasone valerate is a potent glucocorticoid with anti-inflammatory, antipruritic and vasoconstrictive actions. Absorption depends on the vehicle, skin integrity, inflammation and occlusion. Absorbed medicine follows systemic corticosteroid metabolic pathways, including CYP3A4.

Formulation and product differences

• Betnovate RD cream and ointment are ready-diluted maintenance formulations following control of an acute episode. Cream suits moist or weeping lesions; ointment suits dry, lichenified or scaly lesions.
• Betnovate Lotion suits hairy areas or light application over a larger area and has a paraffin-associated fabric fire risk.
• Betnovate Scalp Application is an aqueous scalp suspension and is directly flammable during and immediately after application.
• Bettamousse is a pressurised scalp foam containing substantial ethanol. It can sting damaged skin and must be kept away from flames, cigarettes and hairdryers.
• Cetostearyl, cetyl or stearyl alcohol may cause local contact reactions. Betnovate RD Cream also contains chlorocresol, which may cause allergic reactions.

Cutaneous foam

Route: Cutaneous

Strengths: 1 mg/g, 0.1%