Betamethasone Dipropionate

Approved Indications:

• Treatment of moderate to severe inflammatory and pruritic dermatoses responsive to corticosteroids, including:
• Eczema (atopic and contact)
• Psoriasis (plaque-type), lichen planus, seborrheic dermatitis
• Dermatitis herpetiformis, nummular dermatitis, and prurigo nodularis

Clinically Accepted Off-Label Uses:

• Alopecia areata (patchy) under dermatologic supervision
• Lichen simplex chronicus and lichenified eczematous conditions
• Management of chronic pruritus in elderly skin lesions not responding to milder steroids

Formulations:

• Topical cream, ointment, lotion, or scalp application (e.g., foam, solution)

Adults and Adolescents (≥12 years):

• Apply a thin layer once or twice daily to affected areas (typically twice daily for short course)
• Duration: up to 2 weeks (maximum 4 weeks total); longer under specialist supervision

Pediatric (<12 years):

• Use only under medical supervision
• Apply once daily for limited areas; restrict duration to minimize growth suppression risk

Elderly:

• Same regimen as adults, but monitor for skin thinning and other corticosteroid side effects

Special Populations (Renal/Hepatic Impairment):

• No specific dosage modifications required due to minimal systemic absorption with proper topical use

Administration Notes:

• Wash hands before and after use unless treating hands
• Avoid application near eyes, mouth, or open wounds
• Do not occlude unless directed

Betamethasone Dipropionate is a potent synthetic glucocorticoid that binds intracellular glucocorticoid receptors, modulating transcription to upregulate anti-inflammatory proteins (e.g., lipocortin-1) and suppress pro-inflammatory cytokines, chemokines, and immune cell activity. It reduces vasodilation, edema, leukocyte migration, and pruritus. Its high glucocorticoid receptor affinity and lipophilicity allow effective penetration into inflamed skin and strong anti-inflammatory action while minimizing systemic exposure.

• Absorption: Minimal when applied to intact skin; absorption increases with damaged, inflamed, or occluded skin
• Distribution: Primarily localized within dermal and epidermal layers
• Metabolism: Systemically absorbed portions metabolized in liver via CYP3A4 to inactive metabolites
• Elimination: Metabolites excreted via urine and feces
• Onset of Action: Relief of itching or inflammation often begins within hours; significant improvement in 2–7 days
• Half-Life: Systemic elimination half-life ~10–14 hours for absorbed drug; clinically not relevant due to low systemic exposure

• Pregnancy: FDA Category C — use only if benefits justify potential fetal risk. Limited systemic absorption reduces potential risk but large-area use should be avoided.
• Lactation: Excretion into breast milk is unlikely with topical use. Avoid applying to breast; minimal infant exposure expected if used on small skin areas away from breast tissue.

• Primary Class: Topical Corticosteroid (Glucocorticoid)
• Potency: Class I (super-high potency) — among the most potent topical steroids

• Known hypersensitivity to betamethasone, other corticosteroids, or formulation excipients
• Primary skin infections caused by bacteria, viruses, or fungi (unless adequate antimicrobial therapy is also used)
• Rosacea, acne vulgaris, perioral dermatitis, and ulcerated or thin-skinned areas unless directed
• Pediatric use for prolonged periods without clinician supervision

• High-risk Groups: Infants, children, elderly, patients with impaired skin integrity
• Toxicity Risks: Skin atrophy, telangiectasia, striae, hypopigmentation, delayed wound healing, suppression of HPA axis with extended use
• Monitoring: Visual inspection of treated areas periodically; avoid long-term or extensive occlusive use
• Adverse Signal: Discontinue if signs of infection, allergy, or systemic effects occur
• Black Box Warnings: None

Skin-related (Common):

• Burning, stinging, itching, irritation upon application
• Pruritus, dryness

Less Common:

• Skin thinning, striae, telangiectasia with prolonged use
• Hypopigmentation or hypertrichosis
• Folliculitis

Rare / Serious:

• Secondary skin infection
• Allergic contact dermatitis
• Systemic cortisol suppression symptoms (e.g., Cushingoid features), especially with extensive, prolonged use

Onset & Severity:

• Irritative effects occur early; structural skin changes arise with extended or high‑potency exposure
• Severity is related to potency and application frequency

• Minimal systemic interaction potential due to topical use
• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may reduce systemic clearance if significant absorption occurs, increasing risk of suppression
• Concurrent use of occlusive dressings, other topical steroids, or irritants may increase absorption and adverse effects

• Clinical guidelines emphasize limiting duration of potent topical steroids to minimize HPA-axis suppression and skin atrophy
• Super‑high potency corticosteroids like betamethasone dipropionate recommended only for short-term, localized use
• Newer formulations (e.g. foam, emollient vehicles) improve tolerability while maintaining efficacy

• Store at 20 °C to 25 °C (68–77 °F)
• Keep in a dry place, protected from light
• Keep the container tightly closed when not in use
• Do not freeze
• Keep out of reach of children