. Beclometasone dipropionate 0.025%
. Betamethasone and clioquinol
Very potent with antimicrobials
. Clobetasol with neomycin and nystatin
Children, especially infants, are particularly susceptible to
side-effects. However, concern about the safety of topical
corticosteroids in children should not result in the child
being undertreated. The aim is to control the condition as
well as possible; inadequate treatment will perpetuate the
condition. A mild corticosteroid such as hydrocortisone 0.5%
or 1% is useful for treating nappy rash and hydrocortisone
1% for atopic eczema in childhood. A moderately potent or
potent corticosteroid may be appropriate for severe atopic
eczema on the limbs, for 1–2 weeks only, switching to a less
potent preparation as the condition improves. In an acute
flare-up of atopic eczema, it may be appropriate to use more
potent formulations of topical corticosteroids for a short
period to regain control of the condition. A very potent
corticosteroid should be initiated under the supervision of a
specialist. Carers of young children should be advised that
treatment should not necessarily be reserved to ‘treat only
the worst areas’ and they may need to be advised that
patient information leaflets may contain inappropriate
advice for the patient’s condition.
MHRA/CHM ADVICE: CORTICOSTEROIDS: RARE RISK OF CENTRAL
SEROUS CHORIORETINOPATHY WITH LOCAL AS WELL AS SYSTEMIC
Central serous chorioretinopathy is a retinal disorder
that has been linked to the systemic use of
corticosteroids. Recently, it has also been reported after
local administration of corticosteroids via inhaled and
intranasal, epidural, intra-articular, topical dermal, and
periocular routes. The MHRA recommends that patients
should be advised to report any blurred vision or other
visual disturbances with corticosteroid treatment given
by any route; consider referral to an ophthalmologist for
evaluation of possible causes if a patient presents with
l CONTRA-INDICATIONS Acne . perioral dermatitis . potent
corticosteroids in widespread plaque psoriasis .rosacea (in
adults). untreated bacterial, fungal or viral skin lesions
caution required—treatment should be limited to
specialist supervision (in children). use potent or very
potent topical corticosteroids under specialist supervision
in psoriasis (can result in rebound relapse, development of
generalised pustular psoriasis, and local and systemic
▶ Uncommon Skin reactions .telangiectasia
▶ Rare or very rare Adrenal suppression . hypertrichosis . skin depigmentation (may be reversible)
▶ Frequency not known Local reaction
SIDE-EFFECTS, FURTHER INFORMATION Side-effects
applicable to systemic corticosteroids may also apply if
absorption occurs following topical and local use. In order
to minimise the side-effects of a topical corticosteroid, it is
important to apply it thinly to affected areas only, no more
frequently than twice daily, and to use the least potent
formulation which is fully effective.
l DIRECTIONS FOR ADMINISTRATION Topical corticosteroid
preparations should be applied no more frequently than
twice daily; once daily is often sufficient. Topical
corticosteroids should be spread thinly on the skin but in
sufficient quantity to cover the affected areas. The length
of cream or ointment expelled from a tube may be used to
specify the quantity to be applied to a given area of skin.
This length can be measured in terms of a fingertip unit
(the distance from the tip of the adult index finger to the
first crease). One fingertip unit (approximately 500 mg
from a tube with a standard 5 mm diameter nozzle) is
sufficient to cover an area that is twice that of the flat adult
handprint (palm and fingers). Mixing topical preparations
on the skin should be avoided where possible; several
minutes should elapse between application of different
▶ In children ‘Wet-wrap bandaging’ increases absorption into
the skin, but should be initiated only by a dermatologist
and application supervised by a healthcare professional
l PRESCRIBING AND DISPENSING INFORMATION The potency
of each topical corticosteroid should be included on the
label with the directions for use. The label should be
attached to the container (for example, the tube) rather
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer corticosteroid creams
and ointments. If a patient is using topical corticosteroids
of different potencies, the patient should be told when to
use each corticosteroid. Patients and their carers should be
reassured that side effects such as skin thinning and
systemic effects rarely occur when topical corticosteroids
1242 Inflammatory skin conditions BNF 78
Alclometasone dipropionate 21-Dec-2017
Inflammatory skin disorders such as eczemas
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
▶ Alclometasone dipropionate cream 0.05%: moderate
▶ In children Licensed for use in children (age range not
l PATIENT AND CARER ADVICE Patients or carers should be
counselled on the application of alclometasone
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol, propylene glycol
▶ Alclometasone dipropionate (Non-proprietary)
Alclometasone dipropionate 500 microgram per 1 gram Boots
Derma Care Eczema & Dermatitis Flare-Up 0.05% cream | 15 gram p s
Beclometasone dipropionate 04-Jan-2016
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
▶ Beclometasone dipropionate cream and ointment
▶ In children Not licensed for use in children under 1 year.
l INTERACTIONS → Appendix 1: corticosteroids
l SIDE-EFFECTS Vasodilation . vision blurred
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: cream, ointment
CAUTIONARY AND ADVISORY LABELS 28
▶ Beclometasone dipropionate (Non-proprietary)
Beclometasone dipropionate 250 microgram per
1 gram Beclometasone 0.025% cream | 30 gram P £68.00 DT =
CAUTIONARY AND ADVISORY LABELS 28
▶ Beclometasone dipropionate (Non-proprietary)
Beclometasone dipropionate 250 microgram per
1 gram Beclometasone 0.025% ointment | 30 gram P £68.00 DT
l DRUG ACTION Betamethasone has very high glucocorticoid
activity and insignificant mineralocorticoid activity.
Severe inflammatory skin disorders such as eczemas
unresponsive to less potent corticosteroids | Psoriasis
▶ Child: Apply 1–2 times a day, to be applied thinly
▶ Adult: Apply 1–2 times a day, to be applied thinly
▶ Betamethasone valerate 0.025% cream and ointment:
moderate. Betamethasone valerate 0.1% cream, lotion,
ointment, and scalp application: potent.
Betamethasone valerate 0.12% foam: potent.
Betamethasone dipropionate 0.05% cream, lotion, and
▶ In children Betacap ®, Betnovate ® and Betnovate-RD ® are
not licensed for use in children under 1 year. Bettamousse ®
is not licensed for use in children under 6 years.
l CAUTIONS Use of more than 100 g per week of 0.1%
preparation likely to cause adrenal suppression
l INTERACTIONS → Appendix 1: corticosteroids
l PATIENT AND CARER ADVICE Patient counselling is advised
for betamethasone cream, ointment, scalp application and
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: cream, ointment
CAUTIONARY AND ADVISORY LABELS 15, 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
▶ Bettamousse (RPH Pharmaceuticals AB)
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Bettamousse 0.1% cutaneous foam | 100 gram P £9.75
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), chlorocresol
▶ Betamethasone (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Betamethasone valerate 0.1% cream | 15 gram P £3.00
| 30 gram P £5.99 DT = £1.61 | 100 gram P £11.99 DT =
▶ Audavate (Auden McKenzie (Pharma Division) Ltd, Actavis UK Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram per
1 gram Audavate RD 0.025% cream | 100 gram P £2.99 DT =
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Audavate 0.1% cream | 30 gram P £1.14 DT = £1.61 |
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram per
1 gram Betnovate RD 0.025% cream | 100 gram P £3.15 DT =
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Betnovate 0.1% cream | 30 gram P £1.43 DT = £1.61 | 100 gram P £4.05 DT = £5.37
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate)
BNF 78 Eczema and psoriasis 1243
CAUTIONARY AND ADVISORY LABELS 28
▶ Betamethasone (Non-proprietary)
Betamethasone (as Betamethasone valerate) 1 mg per
▶ Audavate (Auden McKenzie (Pharma Division) Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram per
1 gram Audavate RD 0.025% ointment | 100 gram P £2.99 DT =
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Audavate 0.1% ointment | 30 gram P £1.36 DT = £1.62 |
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 250 microgram per
1 gram Betnovate RD 0.025% ointment | 100 gram P £3.15 DT =
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Betnovate 0.1% ointment | 30 gram P £1.43 DT = £1.62
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate)
CAUTIONARY AND ADVISORY LABELS 15(scalp lotion only), 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens)
▶ Betacap (Dermal Laboratories Ltd)
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Betacap 0.1% scalp application | 100 ml P £3.75 DT =
▶ Betnovate (GlaxoSmithKline UK Ltd)
Betamethasone (as Betamethasone valerate) 1 mg per
1 gram Betnovate 0.1% scalp application | 100 ml P £4.99 DT =
Betnovate 0.1% lotion | 100 ml P £4.58 DT = £4.58
▶ Diprosone (Merck Sharp & Dohme Ltd)
Betamethasone (as Betamethasone dipropionate)
500 microgram per 1 ml Diprosone 0.05% lotion | 100 ml P £7.80 DT = £7.80
Combinations available: Betamethasone with clioquinol,
with neomycin, p. 1164 . Betamethasone with salicylic acid,
Calcipotriol with betamethasone
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, calcipotriol p. 1263, betamethasone p. 1243.
▶ Adult: Apply 1–4 g once daily usual duration of therapy
4 weeks; if necessary, treatment may be continued
beyond 4 weeks or repeated, on the advice of a
specialist, shampoo off after leaving on scalp overnight
or during day, when different preparations containing
calcipotriol used together, maximum total calcipotriol
Mild to moderate plaque psoriasis
▶ Adult: Apply once daily for 8 weeks; if necessary,
treatment may be continued beyond 8 weeks or
repeated, on the advice of a specialist, apply to
maximum 30% of body surface, when different
preparations containing calcipotriol used together,
max. total calcipotriol 5 mg in any one week; maximum
▶ Adult: Apply once daily for 4 weeks; if necessary,
treatment may be continued beyond 4 weeks or
repeated, on the advice of a specialist, apply to a
maximum 30% of body surface, when different
preparations containing calcipotriol used together,
max. total calcipotriol 5 mg in any one week; maximum
▶ Adult: Apply once daily to be applied to the affected
area for up to 4 weeks—consult product literature for
further information; maximum 15 g per day
ENSTILAR ® Erythrodermic psoriasis . pustular psoriasis
l INTERACTIONS → Appendix 1: corticosteroids . vitamin D
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (September
2016) that calcipotriol with betamethasone (Enstilar ®) is
accepted for use within NHS Scotland for the treatment of
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxytoluene
Calcipotriol (as Calcipotriol hydrate) 50 microgram per 1 gram,
Betamethasone (as Betamethasone dipropionate)
Calcipotriol (as Calcipotriol monohydrate) 50 microgram per
1 gram, Betamethasone (as Betamethasone dipropionate)
500 microgram per 1 gram Enstilar 50micrograms/g / 0.5 mg/g
cutaneous foam | 60 gram P £39.68 DT = £39.68 | 120 gram P £79.36
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Butylated hydroxytoluene
Calcipotriol (as Calcipotriol monohydrate) 50 microgram per
1 gram, Betamethasone (as Betamethasone dipropionate)
500 microgram per 1 gram Dovobet gel | 60 gram P £37.21 DT
Clobetasol propionate 21-Dec-2017
Short-term treatment only of severe resistant
inflammatory skin disorders such as recalcitrant
eczemas unresponsive to less potent corticosteroids |
▶ Child 1–17 years: Apply 1–2 times a day for up to
▶ Adult: Apply 1–2 times a day for up to 4 weeks, to be
applied thinly, maximum 50 g of 0.05% preparation per
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