Version May 2024
Note: Base dosage on severity of disease and patient response. Use lowest dose possible for shortest period of time to avoid HPA axis suppression. Therapy should be discontinued when control is achieved.
Corticosteroid-responsive dermatoses: Topical:
Cream, augmented formulation: Betamethasone dipropionate 0.05%: Apply once or twice daily (maximum: 50 g weekly).
Cream, unaugmented formulation:
Betamethasone dipropionate 0.05%: Apply once daily; may increase to twice daily if needed
Betamethasone valerate 0.1%: Apply 1 to 3 times daily. Note: Once- or twice-daily applications are usually effective.
Foam: Apply to the scalp twice daily, once in the morning and once at night. Note: Reassess if no improvement after 2 weeks of treatment.
Gel, augmented formulation: Apply once or twice daily (maximum: 50 g weekly). Note: Reassess if no improvement after 2 weeks of treatment.
Lotion, augmented formulation: Betamethasone dipropionate 0.05%: Apply a few drops once or twice daily (maximum: 50 mL weekly). Note: Reassess if no improvement after 2 weeks of treatment.
Lotion, unaugmented formulation:
Betamethasone dipropionate 0.05%: Apply a few drops twice daily
Betamethasone valerate 0.1%: Apply a few drops twice daily; may consider increasing dose for resistant cases. Following improvement, may apply once daily.
Ointment, augmented formulation: Betamethasone dipropionate 0.05%: Apply once or twice daily (maximum: 50 g weekly). Note: Reassess if no improvement after 2 weeks of treatment.
Ointment, unaugmented formulation:
Betamethasone dipropionate 0.05%: Apply once daily; may increase to twice daily if needed
Betamethasone valerate 0.1%: Apply 1 to 3 times daily. Note: Once- or twice-daily applications are usually effective.
Plaque psoriasis: Topical:
Patch [Canadian product]: Betamethasone valerate: Apply 1 patch (2.25 mg) to each affected area once daily [up to 5 patches (11.25 mg) may be applied daily]; maximum duration of therapy: 30 days.
Spray, unaugmented formulation: Betamethasone dipropionate 0.05%: Apply twice daily for up to 4 weeks
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing. Use the lowest effective dose.
(For additional information see "Betamethasone (topical): Pediatric drug information")
Note: Dosage should be based on severity of disease and patient response; use smallest amount for shortest period of time to avoid HPA axis suppression. Therapy should be discontinued when control is achieved.
Dermatoses (corticosteroid-responsive):
Betamethasone valerate:
Cream 0.1%, ointment 0.1%: Children and Adolescents: Topical: Apply a thin film to the affected area once to 3 times daily; usually once- or twice-daily application is effective.
Lotion 0.1%: Children and Adolescents: Topical: Apply a few drops to the affected area twice daily in the morning and at night; in some cases, more frequent application may be necessary; following improvement reduce to once-daily application.
Betamethasone dipropionate (unaugmented formulation):
Cream 0.05%, ointment 0.05%: Adolescents: Topical: Apply a thin film to affected area once daily; in some cases, twice-daily dosing may be necessary.
Lotion 0.05%: Adolescents: Topical: Apply a few drops to the affected area twice daily, in the morning and night; rub in gently until it disappears.
Betamethasone dipropionate (augmented formulation):
Cream 0.05%, ointment 0.05%: Adolescents: Topical: Apply a thin film to affected area once or twice daily; maximum dose: 50 g/week; evaluate continuation of therapy if no improvement within 2 weeks of treatment.
Gel 0.05%: Children ≥12 years and Adolescents: Topical: Apply a thin layer to the affected area once or twice daily; rub in gently; maximum dose: 50 g/week; not recommended for use longer than 2 weeks.
Lotion 0.05%: Adolescents: Topical: Apply a few drops to the affected area once or twice daily; rub in gently; maximum dose: 50 mL/week; not recommended for use for longer than 2 weeks.
Psoriasis (plaque), treatment: Adolescents ≥18 years of age: Betamethasone dipropionate spray 0.05%: Topical: Apply spray to affected area twice daily and rub in gently for up to 4 weeks.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Local: Application-site reaction (includes application-site atrophy, application-site burning, application-site irritation, application-site pain, application-site pruritus, stinging of the skin)
1% to 10%:
Dermatologic: Acne vulgaris, alopecia, pruritus (≤2%), xeroderma (4%)
Nervous system: Paresthesia
Ophthalmic: Conjunctivitis
<1%:
Dermatologic: Dermatitis, erythema of skin, folliculitis, skin discoloration, skin rash, telangiectasia
Endocrine & metabolic: Hyperglycemia
Gastrointestinal: Dysgeusia
Local: Localized vesiculation
Frequency not defined:
Dermatologic: Acneiform eruption, allergic contact dermatitis, atrophic striae, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, skin atrophy, skin tightness (including cracking)
Endocrine & metabolic: HPA axis suppression
Postmarketing:
Hypersensitivity: Hypersensitivity reaction
Infection: Secondary infection
Ophthalmic: Cataract, glaucoma, increased intraocular pressure, retinopathy (central serous chorioretinopathy)
Hypersensitivity to betamethasone, other corticosteroids, or any component of the formulation
Spray: There are no contraindications listed in the manufacturer's labeling.
Canadian labeling: Additional contraindications (not in US labeling): Treatment of rosacea, acne vulgaris, perioral dermatitis, or pruritus without inflammation (foam); viral diseases (eg, herpes simplex, chicken pox, vaccina); untreated bacterial, fungal, parasitic, syphilis, and tubercular infection involving the skin; eruptions following vaccinations (patch); application to eyes (foam); <18 years of age (patch). Note: Product labels may vary (refer also to product labels).
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Contact dermatitis: Allergic contact dermatitis can occur and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.
• Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to varicella zoster (chickenpox) should be avoided; corticosteroids should not be used to treat ocular herpes simplex.
• Ocular effects: Topical corticosteroids, including betamethasone, may increase the risk of posterior subcapsular cataracts and glaucoma. Monitor for ocular symptoms. Avoid contact with eyes.
• Skin reactions: Discontinue if skin irritation or contact dermatitis occurs; do not use in patients with decreased skin circulation.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome (rare), hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, application to large surface areas, or prolonged use.
Special populations:
• Pediatric: Use of augmented formulations in patients <13 years of age is not recommended. For all formulations, children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients. Use lowest dose possible for shortest period of time to avoid HPA axis suppression.
Dosage form specific issues:
• Appropriate use: For topical use only; avoid contact with eyes. Not for oral, ophthalmic, or intravaginal use. Do not use occlusive dressings on weeping or exudative lesions and general caution with occlusive dressings should be observed; adverse effects may be increased. In the presence of a fungal or bacterial dermatologic infection, institute appropriate antifungal or antibacterial therapy. If the infection does not resolve promptly, discontinue use until the infection has been adequately controlled.
• Augmented (eg, very high potency) products: Use of augmented formulations in patients <13 years of age is not recommended. Not for treatment of rosacea, perioral dermatitis, or if skin atrophy is present at treatment site; not for facial, groin, axillary, oral, ophthalmic, or intravaginal use; not for use in a diapered area. Avoid concurrent use of other corticosteroids.
• Flammable contents: Foam contains flammable propellants. Avoid fire, flame and smoking during and immediately following administration.
• Patch [Canadian product]: Has not been studied in psoriasis of the face, scalp or intertriginous areas; contains methyl and propyl parahydroxybenzoate, which may cause hypersensitivity (sometimes delayed).
Other warnings/precautions:
• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose by reducing the frequency of application or substitution of a less potent steroid.
The extent of percutaneous absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Infants and small children may be more susceptible to HPA axis suppression, intracranial hypertension, Cushing syndrome, or other systemic toxicities due to larger skin surface area to body mass ratio. HPA axis suppression was observed in 32% of infants and children (age range: 3 months to 12 years) being treated with betamethasone dipropionate cream (0.05%) for atopic dermatitis in an open-label trial (n=60); the incidence was greater younger patients vs older children (mean reported incidence for age ranges: ≤1 year: 50%; 2 to 8 years: 32% to 38%; 9 to 12 years: 17%).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External, as dipropionate [strength expressed as base]:
Generic: 0.05% (15 g, 45 g)
Cream, External, as dipropionate augmented [strength expressed as base]:
Diprolene AF: 0.05% (15 g [DSC], 50 g [DSC])
Generic: 0.05% (15 g, 50 g)
Cream, External, as valerate [strength expressed as base]:
Generic: 0.1% (15 g, 45 g)
Emulsion, External, as dipropionate [strength expressed as base]:
Sernivo: 0.05% (120 mL) [contains cetostearyl alcohol, methylparaben, propylparaben]
Foam, External, as valerate:
Luxiq: 0.12% (50 g [DSC], 100 g [DSC]) [cfc free; contains alcohol, usp, cetyl alcohol, propylene glycol]
Generic: 0.12% (50 g, 100 g)
Gel, External, as dipropionate augmented [strength expressed as base]:
Generic: 0.05% (15 g, 50 g)
Lotion, External, as dipropionate [strength expressed as base]:
Generic: 0.05% (60 mL)
Lotion, External, as dipropionate augmented [strength expressed as base]:
Generic: 0.05% (30 mL, 60 mL)
Lotion, External, as valerate [strength expressed as base]:
Generic: 0.1% (60 mL)
Ointment, External, as dipropionate [strength expressed as base]:
Generic: 0.05% (15 g, 45 g)
Ointment, External, as dipropionate augmented [strength expressed as base]:
Diprolene: 0.05% (15 g [DSC], 50 g [DSC])
Diprolene: 0.05% (15 g, 50 g) [contains propylene glycol]
Generic: 0.05% (15 g, 45 g, 50 g)
Ointment, External, as valerate [strength expressed as base]:
Generic: 0.1% (15 g, 45 g)
May be product dependent
Cream (Betamethasone Dipropionate Aug External)
0.05% (per gram): $0.31 - $5.58
Cream (Betamethasone Dipropionate External)
0.05% (per gram): $2.77 - $3.52
Cream (Betamethasone Valerate External)
0.1% (per gram): $1.49 - $1.87
Emulsion (Sernivo External)
0.05% (per mL): $10.90
Foam (Betamethasone Valerate External)
0.12% (per gram): $6.54
Gel (Betamethasone Dipropionate Aug External)
0.05% (per gram): $4.10
Lotion (Betamethasone Dipropionate Aug External)
0.05% (per mL): $2.50 - $3.18
Lotion (Betamethasone Dipropionate External)
0.05% (per mL): $0.75 - $0.80
Lotion (Betamethasone Valerate External)
0.1% (per mL): $1.20
Ointment (Betamethasone Dipropionate Aug External)
0.05% (per gram): $4.23 - $5.55
Ointment (Betamethasone Dipropionate External)
0.05% (per gram): $3.14 - $4.10
Ointment (Betamethasone Valerate External)
0.1% (per gram): $1.36 - $1.39
Ointment (Diprolene External)
0.05% (per gram): $8.32
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Betaderm: 0.05% (15 g, 454 g)
Celestoderm V/2: 0.05% ([DSC])
Generic: 0.05% (450 g)
Cream, External, as dipropionate [strength expressed as base]:
Diprosone: 0.05% (15 g, 50 g) [contains cetyl alcohol, chlorocresol (chloro-m-cresol)]
TARO-Sone: 0.05% (15 g, 50 g, 450 g)
Generic: 0.05% (15 g, 50 g, 450 g)
Cream, External, as dipropionate augmented [strength expressed as base]:
Generic: 0.05% (15 g, 50 g)
Cream, External, as valerate [strength expressed as base]:
Betaderm: 0.1% (15 g, 454 g)
Celestoderm V: 0.1% ([DSC])
Generic: 0.1% (15 g, 450 g)
Lotion, External:
Generic: 0.05% (60 mL)
Lotion, External, as dipropionate [strength expressed as base]:
Diprosone: 0.05% (75 mL) [contains isopropyl alcohol]
TARO-Sone: 0.05% ([DSC])
Generic: 0.05% (30 mL, 75 mL)
Lotion, External, as dipropionate augmented [strength expressed as base]:
Generic: 0.05% (30 mL, 60 mL)
Lotion, External, as valerate [strength expressed as base]:
Betaderm: 0.1% (30 mL, 75 mL)
Valisone Scalp: 0.1% ([DSC])
Generic: 0.1% (30 mL, 60 mL, 75 mL)
Ointment, External:
Betaderm: 0.05% (15 g, 454 g)
Celestoderm V/2: 0.05% ([DSC])
Ointment, External, as dipropionate [strength expressed as base]:
Diprosone: 0.05% (15 g, 50 g)
Generic: 0.05% (15 g, 50 g, 450 g)
Ointment, External, as dipropionate augmented [strength expressed as base]:
Diprolene: 0.05% (50 g) [contains propylene glycol, propylene glycol stearate]
Generic: 0.05% (15 g, 50 g)
Ointment, External, as valerate [strength expressed as base]:
Betaderm: 0.1% (15 g, 454 g)
Celestoderm V: 0.1% ([DSC])
Patch 24 Hour, External:
Beteflam: 2.25 mg (4 ea, 8 ea, 16 ea) [contains edetate (edta) disodium, methylparaben, propylparaben]
Topical:
Cream, ointment: Apply topical sparingly to affected areas. Do not use if atrophy is present at the treatment site. Do not cover with occlusive dressing unless directed otherwise by health care provider. Do not apply very high potency agents to face, groin, axillae, or diaper area. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.
Gel: Apply thin layer to affected area and rub in gently and completely. Do not cover affected area with occlusive dressing. Not for ophthalmic use. Avoid getting into eyes.
Lotion: Apply topical sparingly to affected areas. Massage in gently until lotion disappears. Do not use if atrophy is present at the treatment site. Do not cover with occlusive dressing unless directed otherwise by health care provider. Do not apply very high potency agents to face, groin, axillae, or diaper area. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.
Foam: Invert can and dispense a small amount onto a saucer or other cool surface. Do not dispense directly into hands. Pick up small amounts of foam and gently massage into affected areas until foam disappears. Repeat until entire affected scalp area is treated. Do not cover with occlusive dressing unless directed otherwise by health care provider. Not for ophthalmic use. Avoid getting into eyes.
Patch [Canadian product]: Clean and dry area to be treated prior to each application. May cut patch to size to cover lesion. Peel off protective film and apply adhesive medicated side to affected area; patch should be worn for 20 to 24 hours. After removing patch wait at least 30 minutes before applying a new one. Keep dry; if patch becomes wet, remove and wait until next scheduled dose before applying a new one. Do not cover with occlusive dressing. Patch should not be reused if it comes off; if edges of patch start to lift, apply medical adhesive tape to detached part only.
Spray: Spray directly onto affected areas (spray only enough to sufficiently cover the area); rub in gently and wash hands after applying. Shake well before use. Do not use if atrophy is present at the treatment site. Do not cover with occlusive dressing unless directed otherwise by health care provider. For topical use only; not for oral, ophthalmic or vaginal use; avoid use on the face, scalp, axilla, groin, or other intertriginous areas.
Topical: For external use only. Apply sparingly to affected areas. Not for use on broken skin or in areas of infection. Do not apply to wet skin unless directed; do not cover with occlusive dressing unless directed. Do not apply very high potency agents to face, groin, axillae, or diaper area; avoid contact with eyes. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.
Betamethasone dipropionate spray: Spray directly onto affected areas (spray only enough to sufficiently cover the area); rub in gently. Shake well before use. Do not use if atrophy is present at the treatment site. Avoid use on the face, scalp, axilla, groin, or other intertriginous areas.
Lotion: Shake well prior to use. Massage gently until lotion disappears.
Dermatoses: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Dermatoses of the scalp (foam): Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses of the scalp.
Plaque psoriasis (spray; patch [Canadian product]): Treatment of mild to moderate plaque psoriasis in patients 18 years and older.
Luxiq may be confused with Lasix
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Betamethasone (Topical). Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Corticosteroids (Topical). Risk C: Monitor therapy
Topical corticosteroids may be used for the treatment of corticosteroid-responsive dermatosis, such as atopic dermatitis, in patients planning a pregnancy (Vestergaard 2019).
Systemic bioavailability of topical corticosteroids is variable (eg, integrity of skin, use of occlusion) and may be further influenced by trimester of pregnancy (Chi 2017). In general, the use of topical corticosteroids is not associated with a significant risk of adverse pregnancy outcomes. However, there may be an increased risk of low birth weight infants following maternal use of potent or very potent topical products, especially in high doses, although this risk is likely to be low (Andersson 2021; Chi 2015; Chi 2017).
When first-line treatments, such as emollients, are insufficient, topical corticosteroids may be used for the treatment of atopic dermatitis in pregnant patients (Vestergaard 2019). Topical corticosteroids are classified by potency; the medication and formulation (eg, cream, gel, and/or salt form) contribute to the potency classification (Oakley 2021; Stacey 2021; Tadicherla 2009). In general, use of the least potent product in limited amounts is recommended during pregnancy. Mild to moderate potency corticosteroids are preferred; potent to very potent topical corticosteroids should only be used as alternative therapy in limited amounts under obstetrical care. Pregnant patients should avoid application of topical corticosteroids to areas with high percutaneous absorption (eg, armpit, skin folds, vulva) (Chi 2017), and caution should be used when applying to areas prone to striae formation (eg, abdomen, breast, thighs) (Vestergaard 2019).
It is not known if systemic absorption following topical administration results in detectable quantities of betamethasone in breast milk.
Systemic corticosteroids are present in breast milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother; however, topical corticosteroids are generally considered acceptable for use in patients who are breastfeeding (Butler 2014; WHO 2002).
Avoid application of topical corticosteroids to the nipple and areola area until breastfeeding ceases; hypertension was noted in a breastfed infant when a high potency topical corticosteroid was applied to the nipple (AAD-NPF [Elmets 2021]; Butler 2014; Leachman 2006). If needed, apply topical corticosteroids immediately after breastfeeding, then clean nipples prior to the next feeding (Vestergaard 2019).
HPA axis suppression and adrenal insufficiency, especially in children or with augmented formulation use; ocular symptoms. Foam, gel, lotion (augmented), and ointment (augmented): reassess if no improvement after 2 weeks of treatment.
Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Betamethasone has intermediate to very high range potency (dosage-form dependent).
Absorption: Topical corticosteroids are absorbed percutaneously. The extent of absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children.
Metabolism: Hepatic
Excretion: Urine and bile
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