Betamethasone + Calcipotriol

• Approved Indications:
• Topical treatment of stable plaque psoriasis (mild to moderate severity) on the body and scalp.
• Management of psoriatic plaques to reduce scaling, redness, and thickness.
• Clinically Accepted Off-Label Uses:
• Treatment of other inflammatory dermatoses responsive to corticosteroids and vitamin D analogues, under specialist guidance.
• Use as adjunct therapy in psoriasis with extensive involvement or resistant lesions.

• Formulation and Route:
• Topical ointment, cream, or gel applied to affected skin areas.
• Adults:
• Apply a thin layer once or twice daily (usually twice daily) to affected areas.
• Treatment duration typically up to 4 weeks; may extend with physician approval.
• Pediatrics:
• Use with caution; safety and efficacy in children under 12 years not well established.
• Apply under medical supervision; minimize duration.
• Elderly:
• No specific dose adjustments; use cautiously due to increased skin sensitivity.
• Special Populations:
• Avoid use on large body surface areas to reduce risk of systemic absorption.
• Administration Notes:
• Avoid contact with eyes and mucous membranes.
• Do not use occlusive dressings unless prescribed.
• Wash hands after application unless treating the hands.

Betamethasone is a potent corticosteroid that exerts anti-inflammatory, immunosuppressive, and antiproliferative effects by binding to glucocorticoid receptors, modulating gene transcription to suppress pro-inflammatory cytokines and immune cell activation. Calcipotriol, a synthetic vitamin D3 analogue, regulates keratinocyte proliferation and differentiation by binding to vitamin D receptors, normalizing epidermal cell growth and reducing psoriatic plaque formation. The combination offers synergistic effects, balancing inflammation suppression with normalization of skin cell turnover.

• Absorption: Both agents are minimally absorbed systemically when applied topically on intact skin; increased absorption possible with extensive application or occlusion.
• Distribution: Localized primarily to the epidermis and dermis; minimal systemic distribution.
• Metabolism: Betamethasone metabolized hepatically after systemic absorption; calcipotriol metabolized to less active metabolites.
• Elimination: Metabolites excreted mainly via urine and feces.
• Half-Life: Systemic half-life not clinically significant due to minimal absorption.
• Onset: Clinical improvement usually observed within 1–2 weeks of consistent use.

• Pregnancy: Category C – Use only if potential benefits justify the potential risk to the fetus. Topical use with limited systemic absorption; however, avoid large area application.
• Lactation: Unknown if excreted in breast milk; caution advised. Use only on small areas and avoid breast contact during treatment.

• Combination topical corticosteroid and vitamin D3 analogue.
• Betamethasone: potent glucocorticoid.
• Calcipotriol: vitamin D3 receptor agonist.

• Known hypersensitivity to betamethasone, calcipotriol, or formulation excipients.
• Patients with disorders of calcium metabolism (e.g., hypercalcemia, vitamin D toxicity).
• Presence of untreated bacterial, viral, or fungal skin infections at application sites.
• Use on face, groin, or axillae unless specifically prescribed.

• Avoid prolonged or extensive use to prevent systemic corticosteroid effects and hypercalcemia.
• Monitor for skin atrophy, telangiectasia, or steroid-induced dermatitis with prolonged use.
• Use cautiously in patients with impaired calcium metabolism or renal insufficiency.
• Discontinue if signs of skin irritation or allergic reactions occur.
• Not recommended for use in children under 12 years unless supervised.

• Common:
• Local skin irritation, burning, itching, erythema
• Dryness or peeling of skin
• Mild hypercalcemia symptoms with excessive use of calcipotriol
• Less Common:
• Skin atrophy, telangiectasia from corticosteroid
• Allergic contact dermatitis
• Folliculitis
• Rare / Serious:
• Systemic corticosteroid effects (rare with topical use)
• Hypercalcemia and related symptoms (headache, nausea) with overuse
• Secondary skin infections due to immunosuppression

• Concomitant use with other topical corticosteroids or vitamin D analogues increases risk of adverse effects.
• Avoid simultaneous use with UV light therapy or tanning beds unless directed by a physician, due to increased risk of photosensitivity.
• No significant systemic drug interactions expected due to minimal absorption.

• Clinical guidelines recommend combination therapy for enhanced efficacy and reduced corticosteroid dose compared to monotherapy.
• Emphasis on limiting duration of use to reduce side effects.
• New formulations focus on improving tolerability and adherence in plaque psoriasis.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and direct sunlight.
• Keep container tightly closed.
• Keep out of reach of children.