Betamethasone valerate and hydrocortisone.Topical corticosteroids for childhood eczema: clearing up the confusion
They come as: creams ointments lotions scalp treatments lotions and foams medicated plasters They're stronger than some other treatments, such as hydrocortisone skin creams. You're more likely to have a serious side effect if you use betamethasone on a large area of skin for a long time. Do this over 1 to 2 weeks before stopping it completely.
Betamethasone skin treatments work on your skin's cells to stop these chemicals being released. This reduces any swelling, redness and itching.
Your skin should start to get better after using betamethasone for a few days. If you're using cream, ointment or lotion, speak to your doctor if there is no improvement after 4 weeks, or if your skin gets worse at any time. Ask your doctor how long it should take to show an improvement if you are using the scalp foam or are using betamethasone on your face. They will tell you what to do if it does not work.
For long-term skin problems, such as eczema or psoriasis, you may need to use the skin treatments for a week or two, or sometimes for longer. To reduce the risk of side effects, your doctor may recommend that you only use betamethasone skin treatments for a few weeks at a time or for a day or two each week.
Tell your doctor if your skin gets worse or does not improve within 2 to 4 weeks. Once your skin is better, you can use moisturisers to keep it from becoming inflamed again. Do not use betamethasone skin cream, ointment or lotion for more than 4 weeks without talking to your doctor. If you need treatment for a long time, they may decide you need to use a milder cream or ointment. Talk to your doctor before stopping treatment if you've been using betamethasone for a long time.
They may tell you to gradually use less of it, and use it less often, before you stop completely. This reduces the chance of your symptoms coming back. Using betamethasone for a long time without stopping can mean some of the medicine gets into your bloodstream.
If this happens, there's a very small chance it can cause serious side effects, such as adrenal gland problems, high blood sugar hyperglycaemia , thinning of your skin, or problems with your eyesight. If you have been using betamethasone for a long time, your doctor may tell you to gradually reduce the amount you use before stopping completely.
Do not use betamethasone skin products on your face unless a doctor has told you to. The skin on your face is delicate, so if betamethasone skin treatments thin the skin or damage it, it's particularly noticeable. If your doctor tells you that you can use betamethasone on your face, follow their instructions carefully. There's a range of skin treatments available that contain different steroids.
Your doctor will choose a steroid skin treatment for you based on the strength you need to treat your condition. A mild or moderate strength treatment is used for most skin conditions. Potent skin treatments are usually used for short periods of time for severe skin conditions. Usually you will have tried a lower strength steroid skin treatment first before you try betamethasone. The stronger or more potent the steroid is, the better it will work.
However, with stronger steroids there's also more risk of side effects. All steroids have the same side effects but you're less likely to get them with milder steroid skin products. Steroids like betamethasone reduce inflammation in your skin to help manage your symptoms. They do not cure the eczema.
If you feel your symptoms are getting worse after using betamethasone for 1 week, it's important to tell a doctor. When you stop using betamethasone skin treatments, skin conditions like eczema and psoriasis can flare up again. You can avoid this by gradually reducing the amount you put on, and how often you use it.
Do this over 1 to 2 weeks before stopping it completely. But tell the doctor or nurse that you're using betamethasone skin treatments so they can give the vaccine in an untreated area of skin.
There's no clear evidence that betamethasone affects male or female fertility. However, speak to a pharmacist or your doctor if you're trying to get pregnant.
Betamethasone does not interfere with any types of contraception including the combined pill or the emergency contraception. Betamethasone does not make you sleepy so it's safe to drive, ride a bike or use tools or machinery when using this medicine. Page last reviewed: 21 August Next review due: 21 August Betamethasone for skin - Brand names: Betnovate, Betacap On this page About betamethasone for skin Key facts Who can and cannot use betamethasone for skin How and when to use betamethasone for skin Side effects Pregnancy and breastfeeding Cautions with other medicines Common questions about betamethasone.
About betamethasone for skin Betamethasone skin treatments are used to treat itching, swollen and irritated skin. They come as: creams ointments lotions scalp treatments lotions and foams medicated plasters They're stronger than some other treatments, such as hydrocortisone skin creams. Read about: betamethasone eye, ear and nose treatments — for allergies, inflammation and autoimmune conditions betamethasone tablets and injections — for allergies, inflammation and autoimmune conditions.
Only use a steroid skin treatment if your doctor prescribes it for you. Do not use someone else's medicine. It's important to follow the instructions when using a steroid skin treatment. This helps to avoid side effects. Only use betamethasone on your face if your doctor says it's OK. Betamethasone will not help with skin conditions such as impetigo , rosacea and acne. The consensus of paediatric dermatologists in Australia and New Zealand is that topical corticosteroids can be applied to areas of eczema with broken skin 5 read more.
This recommendation possibly arose as topical corticosteroid absorption will be greater through broken skin. However, this can prevent patients having topical corticosteroids applied to areas of active eczema particularly when severely inflamed or excoriated. All skin with an active eczema flare will have reduced barrier function, and the best way to address this is through appropriate use of topical corticosteroids.
This advice may result in corticosteroids only being used when symptoms are severe, leading to inadequate use and poor symptom control. Arrange to review the patient within two to four weeks of prescribing topical corticosteroids. This gives an opportunity to assess their response to treatment and reinforce education as well as allowing the patient and caregiver to focus on treating the eczema rather than watching for adverse effects.
There are a range of fully funded or partly funded topical corticosteroids available to prescribe for children with eczema Table 2. Key points when selecting the potency of topical corticosteroids include: 2, 5, 7—9, Provide a written plan for the patient and caregiver to take home.
This can help to remind them which topical corticosteroid to apply where. For an example, see: www. Table 2: Prescription only topical corticosteroid potency and currently funded formulations, sizes and brands, as of July, Fully funded Partly funded. For example: 7, 9. Potent strong corticosteroid - apply once daily to eczema on the limbs and trunk until the flare has cleared. Seek medical attention if symptoms persist after seven days.
The face, flexural and groin areas are more susceptible to adverse effects such as striae or skin atrophy and systemic absorption is increased in these areas compared to other sites. In periorbital regions potent or very potent topical corticosteroids should not be used. Topical calcineurin inhibitors are an alternative treatment if the use of topical corticosteroids is contraindicated or not appropriate.
Patients may self-fund for other indications. Calcineurin inhibitors are more likely to cause a burning sensation and pruritis than topical corticosteroids. Check that patients and caregivers understand when to initiate treatment with topical corticosteroids and when treatment should be stepped down or withdrawn: 2, 8, Topical steroids should generally be effective in clearing inflammation so that long-term treatment is primarily with emollients. Calculate how much topical corticosteroid to prescribe and if possible, provide an indication of when a repeat prescription is likely to be required.
Caregivers can use fingertip units FTU to guide the amount of topical corticosteroid to apply Table 3 and Figure 2. One FTU is approximately 0. For example, a child aged five years with eczema mainly affecting one arm and hand will require approximately four FTU of topical corticosteroid per application Table 3.
If this is applied once daily during flares, and flares last approximately seven days in total during a month, this would equate to:. Table 3: Approximate number of adult fingertip units FTU of corticosteroid needed per application for children with eczema. Shortly after application of a topical corticosteroid some patients may experience local irritation or a change in skin colour caused by corticosteroid-induced vasoconstriction.
There is little evidence as to what percentage of a topical corticosteroid dose is absorbed systemically. The National Psoriasis Foundation does not endorse any specific treatment for psoriatic disease. For Patients: Please read the full prescription insert for known side effects, precautions, or warnings. Also, please talk with your provider for the specific dose and frequency that is right for you.
The Foundation does not endorse any medications, products or treatments for psoriasis or psoriatic arthritis and advises you to consult with a physician before initiating any treatment. That is more than 7. Learn about different treatment options for psoriasis and psoriatic arthritis and talk to your doctor about what might be right for you.
The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly.
The application of high-potency steroids can induce a deep-tissue tinea infection known as a Majocchi granuloma. This tinea folliculitis requires oral antifungal therapy. Combinations of antifungal agents and corticosteroids should be avoided to reduce the risk of severe, persistent, or recurrent tinea infections. Topical applications of corticosteroids can also result in hypopigmentation.
This is more apparent with darker skin tones, but can happen in all skin types. Repigmentation often occurs after discontinuing steroid use. Steroids can induce a contact dermatitis in a minority of patients, but many cases result from the presence of preservatives, lanolin, or other components of the vehicle. Non-fluorinated steroids e. Topically applied high- and ultra-high-potency corticosteroids can be absorbed well enough to cause systemic side effects.
Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension, and other systemic side effects have been reported. According to a postmarketing safety review, the most frequently reported side effects were local irritation 66 percent , skin discoloration 15 percent , and striae or skin atrophy 15 percent.
Topical steroids can induce birth defects in animals when used in large amounts, under occlusion, or for long duration. Food and Drug Administration as pregnancy category C. It is unclear whether topical steroids are excreted in breast milk; as a precaution, application of topical steroids to the breasts should be done immediately following nursing to allow as much time as possible before the next feeding.
Children often require a shorter duration of treatment and a lower potency steroid. This content is owned by the AAFP.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. C 1 , 2 , 4 , 9 — 13 Ultra-high-potency topical steroids should not be used continuously for longer than three weeks.
C 21 Low- to high-potency topical steroids should not be used continuously for longer than three months to avoid side effects. C 21 Combinations of topical steroids and antifungal agents generally should be avoided to reduce the risk of tinea infections. Steroid Vehicles. Frequency of Administration and Duration of Treatment. Side Effects.
Back to Medicines A to Z. Betamethasone skin treatments are used to treat itching, swollen and irritated skin. They can help with conditions such as eczemacontact dermatitis and psoriasis. Betamethasone skin treatments are available on prescription only. They come as:. They're stronger than some other treatments, such as hydrocortisone skin creams.
Betamethasone is usually prescribed when other medicines have not worked. Betamethasone is a type of medicine known as a steroid also called a corticosteroid. This is not the same as an anabolic steroid. Sometimes betamethasone is mixed with an antibiotic called fusidic acid.
This is used to treat bacterial skin infections. It also comes as an eye ointment; drops for your eyes, ears or nose; tablets and injections. Most adults aged 18 or over can use betamethasone skin treatments.
Medicated plasters are suitable for adults only. Most other betamethasone skin treatments can be used by children over the age of 1 year. Occasionally a specialist may prescribe them for a younger child. However, some betamethasone creams and foams will only be prescribed for children aged 6 years and older. Betamethasone may not be suitable for some people.
Tell a pharmacist or doctor before using it if you :. Always follow the instructions from a pharmacist, doctor or the leaflet that comes with your medicine. Creams are better for skin that is moist and weepy.
Ointments are thicker and greasier, and are better for dry or flaky areas of skin. You will usually use betamethasone skin cream or ointment once or twice a day. The amount of cream or ointment you need to use is sometimes measured in fingertip units. This is the amount you can squeeze onto the end of your finger.
A fingertip unit of cream is generally enough to treat an area that's twice the size of the palm of your hand. For children, the right amount of cream or ointment depends on their age. A doctor or pharmacist can advise you. If you are prescribed a combination cream containing betamethasone and an antibiotic, follow the instructions that come with your medicine. Do not use betamethasone skin cream or ointment at the same time as any other creams or ointments, such as a moisturiser or emollient.
Wait at least 30 minutes before using any other skin product after you put on betamethasone cream or ointment. Skin creams can dry onto your clothes and bedding. This makes them more likely to catch fire. Avoid naked flames. If you need to use a dressing, like a bandage or plaster, wait at least 10 minutes after putting betamethasone on. If you're treating a child, do not cover the cream or ointment with dressings or bandages.
This can cause more medicine to pass through the skin and into the bloodstream, leading to a higher chance of side effects.
If your doctor has prescribed it to treat very severe nappy rash, ask them how much to use and how long to use it for. Skin lotions can dry onto your clothes and bedding. You will usually use the lotion twice a day. You can use it once a day or less often when your condition improves. If you have washed your hair, dry it properly before using the scalp lotion. You can use the foam up to twice a day. Medicated plasters are for small areas of skin and thickened skin affected by psoriasis.
Do not reuse plasters. Use a new plaster on the same patch of skin every 24 hours. Wait at least 30 minutes between taking off an old plaster and putting on a new one.
Do not get the plaster wet. It's best to have a shower or bath after taking off the old plaster and before putting on a new one. Most people only need to use betamethasone skin treatments for a short time. Stop as soon as your skin is better. Sometimes you only need to use the skin treatments for a few days. If you're using the scalp foam, or are using betamethasone on your face, ask your doctor or pharmacist how long to use it for. If you're using the cream, ointment or lotion, tell your doctor if your skin gets worse or does not improve within 2 to 4 weeks or 5 days for a child.
Children must not use the scalp application or foam for more than 5 to 7 days follow the instructions that come with the medicine. Using more than the recommended amount of your betamethasone skin treatment is unlikely to harm you. If you forget to use your betamethasone skin treatment, do not worry. Use it as soon as you remember unless it's nearly time for your next dose.
In this case, skip the missed dose and apply the next one at the usual time. Betamethasone skin treatments are unlikely to cause any side effects if you follow the instructions. You're more likely to have side effects if you use it on large areas of skin for long periods of time, or on sensitive skin areas such as the face, or under dressings or nappies. Some people get a burning or stinging feeling for a few minutes when they put betamethasone on their skin.
This stops happening after you've been using it for a few days. Serious side effects are rare. They happen to less than 1 in 10, people who use betamethasone skin treatments. You're more likely to have a serious side effect if you use betamethasone on a large area of skin for a long time. Using betamethasone for a long time can make your skin thinner or cause stretch marks. Stretch marks are likely to be permanent, but they usually fade over time.
In very rare cases, using betamethasone for a long time can slow the normal growth of children and teenagers. Your child's doctor will monitor their height and weight carefully if they need to use this medicine often. This will help them to notice if your child's growth is being affected and they can change the treatment if needed. Talk to your doctor if you're worried. They will be able to explain the benefits and risks of your child using betamethasone.
It happens rarely, but it is possible to have a serious allergic reaction anaphylaxis to betamethasone. These are not all the side effects of betamethasone. For a full list, see the leaflet inside your medicine packet. Betamethasone is not usually recommended for use when pregnant. A dermatologist skin care specialist may prescribe it if they feel the benefits outweigh the risks.
Small amounts of betamethasone used on small areas of skin are unlikely to cause any problems in pregnancy. There's not enough research into betamethasone to know if it's safe to use larger amounts in pregnancy. If you're using betamethasone cream or ointment on your breasts, wash off any medicine from your breast, then wash your hands before feeding your baby.
It's usually better to use cream rather than ointment when breastfeeding, as it's easier to wash off. For more information about how betamethasone can affect you and your baby during pregnancyread this leaflet on the Best Use of Medicines in Pregnancy BUMPs website. It's very unlikely that other medicines will affect the way betamethasone skin treatments work.
If you're also using any other skin treatment, make sure you wait about 30 minutes between using betamethasone and using the other skin treatment. There's very little information about taking herbal remedies and supplements while using betamethasone. Ask a pharmacist for advice. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
Betamethasone is a steroid also called a corticosteroid. Steroids help to reduce inflammation in the skin and other parts of your body.
Skin gets inflamed when an allergic reaction or irritation causes chemicals to be released in the skin. These make your blood vessels widen and your irritated skin becomes red, swollen, itchy and painful. Betamethasone skin treatments work on your skin's cells to stop these chemicals being released.
This reduces any swelling, redness and itching. Your skin should start to get better after using betamethasone for a few days. If you're using cream, ointment or lotion, speak to your doctor if there is no improvement after 4 weeks, or if your skin gets worse at any time. Ask your doctor how long it should take to show an improvement if you are using the scalp foam or are using betamethasone on your face.
They will tell you what to do if it does not work. For long-term skin problems, such as eczema or psoriasis, you may need to use the skin treatments for a week or two, or sometimes for longer.
The aims of the studies reported here were to evaluate the efficacy and safety of a new corticosteroid, hydrocortisone buteprate (HBP), in comparison with a. A half-sided, single-blind, comparative study of a new modified formulation of 1% hydrocortisone/10% urea and % betamethasone valerate cream in the.
Use intermediate-potency steroids (e.g., triamcinolone, fluocinolone) for more severe cases and limit potent corticosteroids (e.g., betamethasone. Betamethasone is not the same as hydrocortisone, but both medications are corticosteroids (steroids, for short). Betamethasone valerate % ointment applied for 3 days followed by vehicle for 4 days was as effective as hydrocortisone 1% cream applied for 7 days in an.
While topical steroids require a prescription from a health care provider, there are over-the-counter and non-steroid treatment options available to you without a prescription. If you have washed your hair, dry it properly before using the scalp lotion. Prescribing Reports. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The amount of cream or ointment you need to use is sometimes measured in fingertip units.
Topical corticosteroids are one of the key medicines used in the management of childhood eczema. Common themes contribute to the reluctance of caregivers to use topical corticosteroids Table 1. Addressing these concerns may improve treatment adherence and patient outcomes.
Table 1: Caregiver misconceptions and concerns associated with the use of topical corticosteroids for eczema in children and evidence-based responses. Topical corticosteroids can and should be used for all severities of eczema, including mild symptoms read more. Products have a range of potencies to treat patients with differing symptom severity.
Treatment should be with the mildest topical corticosteroid which is able to resolve the inflammation within a short period of time so that the patient is able to have days without using topical corticosteroids. Different potencies are required for different parts of the body depending on the thickness of the stratum corneum. Topical corticosteroids are unlikely to cause skin thinning or other long-term harm to children if used appropriately read more.
Skin thinning is one of the most frequently cited concerns reported by patients and caregivers, however, is very unlikely to occur if patients and caregivers use topical corticosteroids appropriately. The consensus of paediatric dermatologists in Australia and New Zealand is that topical corticosteroids can be applied to areas of eczema with broken skin 5 read more. This recommendation possibly arose as topical corticosteroid absorption will be greater through broken skin.
However, this can prevent patients having topical corticosteroids applied to areas of active eczema particularly when severely inflamed or excoriated. All skin with an active eczema flare will have reduced barrier function, and the best way to address this is through appropriate use of topical corticosteroids. This advice may result in corticosteroids only being used when symptoms are severe, leading to inadequate use and poor symptom control.
Arrange to review the patient within two to four weeks of prescribing topical corticosteroids. This gives an opportunity to assess their response to treatment and reinforce education as well as allowing the patient and caregiver to focus on treating the eczema rather than watching for adverse effects.
There are a range of fully funded or partly funded topical corticosteroids available to prescribe for children with eczema Table 2. Key points when selecting the potency of topical corticosteroids include: 2, 5, 7—9, Provide a written plan for the patient and caregiver to take home. This can help to remind them which topical corticosteroid to apply where. For an example, see: www. Table 2: Prescription only topical corticosteroid potency and currently funded formulations, sizes and brands, as of July, Fully funded Partly funded.
For example: 7, 9. Potent strong corticosteroid - apply once daily to eczema on the limbs and trunk until the flare has cleared. Seek medical attention if symptoms persist after seven days. The face, flexural and groin areas are more susceptible to adverse effects such as striae or skin atrophy and systemic absorption is increased in these areas compared to other sites.
In periorbital regions potent or very potent topical corticosteroids should not be used. Topical calcineurin inhibitors are an alternative treatment if the use of topical corticosteroids is contraindicated or not appropriate. Patients may self-fund for other indications. Calcineurin inhibitors are more likely to cause a burning sensation and pruritis than topical corticosteroids.
Check that patients and caregivers understand when to initiate treatment with topical corticosteroids and when treatment should be stepped down or withdrawn: 2, 8, Topical steroids should generally be effective in clearing inflammation so that long-term treatment is primarily with emollients.
Calculate how much topical corticosteroid to prescribe and if possible, provide an indication of when a repeat prescription is likely to be required.
Caregivers can use fingertip units FTU to guide the amount of topical corticosteroid to apply Table 3 and Figure 2. One FTU is approximately 0. For example, a child aged five years with eczema mainly affecting one arm and hand will require approximately four FTU of topical corticosteroid per application Table 3.
If this is applied once daily during flares, and flares last approximately seven days in total during a month, this would equate to:. Table 3: Approximate number of adult fingertip units FTU of corticosteroid needed per application for children with eczema. Shortly after application of a topical corticosteroid some patients may experience local irritation or a change in skin colour caused by corticosteroid-induced vasoconstriction.
There is little evidence as to what percentage of a topical corticosteroid dose is absorbed systemically. Studies investigating systemic effects do not measure how much of the corticosteroid is in the blood, but instead focus on measuring cortisol as a marker of hypothalamic-pituitary-adrenal HPA axis suppression.
However, this resolves upon cessation of the topical corticosteroid, without the need for dose tapering. More serious adverse effects include clinically significant HPA axis suppression, skin atrophy or striae or withdrawal symptoms upon stopping the corticosteroid, such as erythema and aggravation of cutaneous symptoms.
If patients request repeat prescriptions earlier than expected consider whether they may be using a topical corticosteroid inappropriately; case reports of adverse effects typically involve patients who have used the product for longer than it was prescribed for. Ask patients to bring their tubes of topical corticosteroids with them to appointments so you can more accurately assess the quantities used.
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Made with by the bpac nz team. Prescribing Reports. CME Quizzes. Peer Group Discussions. My Bpac account. Search Mybpac - Login. Latest Articles View Articles. Prescribing Reports View reports. Audits View all audits. Peer Group Discussions View all discussions. Hello there! Remember me. Child health Dermatology. Topical corticosteroids for childhood eczema: clearing up the confusion Topical corticosteroids are one of the key medicines used in the management of childhood eczema.
Please login to save this article. Log in. Childhood eczema. Childhood eczema: improving adherence to treatment basics. Topical corticosteroids for childhood eczema: clearing up the confusion You are reading this. Download both articles. Published: 4 August This is a revision of a previously published article. Navigating common questions and concerns Topical corticosteroids are one of the key medicines used in the management of childhood eczema.
Topical corticosteroids should only be used for severe symptoms Topical corticosteroids can and should be used for all severities of eczema, including mild symptoms read more Products have a range of potencies to treat patients with differing symptom severity.
Which corticosteroid and formulation to apply There are a range of fully funded or partly funded topical corticosteroids available to prescribe for children with eczema Table 2. However, be prepared to increase potency, particularly for eczema on the trunk and limbs, if a mild topical corticosteroid is not working. Betamethasone valerate 0. Patients can be treated with a higher potency corticosteroid initially to gain control of symptoms and then stepped down to a less potent formulation, e.
This results in quicker resolution of symptoms and shorter treatment duration If patients are switched to higher potency corticosteroids ensure they understand that the treatment period is shorter If a lower potency of corticosteroid is needed, prescribe a weaker corticosteroid rather than diluting a more potent formulation Diluting topical corticosteroids with emollients does not result in a less potent medicine.
Potency is related to the affinity of the particular corticosteroid molecule to the receptor. Very potent topical corticosteroids, i. Recommendations for topical corticosteroid use Where on the body should they be applied? For example: 7, 9 Methylprednisolone aceponate 0. As symptoms improve treatment can be stepped down by either applying a lower potency corticosteroid with the same frequency, or the same potency corticosteroid applied less frequently.
How long should they be applied for? Flares should typically resolve within seven to 14 days of treatment. This consists of applying topical corticosteroids for two days a week during remission. Fingertip unit. The adverse effects of topical corticosteroids are mild and reversible Shortly after application of a topical corticosteroid some patients may experience local irritation or a change in skin colour caused by corticosteroid-induced vasoconstriction.
The risk of these adverse effects is increased: 7, 8 With a higher potency of corticosteroid With application to a greater area of skin or a larger quantity of application When corticosteroids are applied under occlusion or to flexural or groin areas, which increases absorption If patients are also taking oral or high-dose inhaled corticosteroids When potent topical corticosteroids are applied to striae-prone areas, e.
Acknowledgement This article is a revision of an original article published by bpac nz in Topical corticosteroids in treatment of atopic dermatitis: an overview of their current status. JPRI ;:1— Different strategies for using topical corticosteroids in people with eczema.
