Betamethasone valerate

Betamethasone valerate belongs to the potent group of topical corticosteroids. Applied to the skin, it reduces inflammation, redness and itching. The UK SmPC for Betnovate Cream lists atopic eczema (including in infants over one year), discoid eczema, prurigo nodularis, psoriasis other than widespread plaque psoriasis, lichen simplex chronicus, lichen planus, seborrhoeic dermatitis, irritant and allergic contact dermatitis, discoid lupus erythematosus and reactions to insect bites. It is also used alongside oral steroids in generalised erythroderma. A cream base suits moist or weeping skin particularly well.

There is one strength on this page, labelled 0.1%. It is sold by the tube, and you can order 1, 3, 5, 7, 9 or 12 tubes at a time. The cream is an imported generic, so check the tube itself for the exact content and the list of ingredients.

The best-known UK product is Betnovate Cream from GlaxoSmithKline, classed as a prescription-only medicine (POM). Generic Betamethasone valerate 0.1% w/w cream is also authorised, and Betnovate is available as an ointment, lotion and scalp application. A diluted Betnovate RD range is licensed too, for situations where a milder steroid will do. The imported cream offered here does not have its own UK marketing authorisation.

The cream is spread thinly and rubbed in gently, using just enough to cover the affected area, once or twice a day for up to four weeks. When the skin improves, applications become less frequent or a milder preparation takes over, and treatment is reduced gradually rather than stopped at once, because an abrupt stop can bring the rash back. A rash that is no better after two to four weeks needs a fresh look at both the diagnosis and the treatment. Leave time for the cream to sink in before applying a moisturiser. On the face and in children, courses are limited to five days without occlusion; it must not be used on infants under one year. For people who relapse often, a prescriber may suggest a maintenance routine of once a day, twice a week, with emollients every day.

Betamethasone valerate must not be used on untreated skin infections, rosacea, acne, perioral dermatitis, itching without inflammation, or itching around the anus or genitals. Large areas, thin skin, skin folds, broken skin and covering the cream with a dressing (a nappy counts) all increase absorption into the body. Taken together with strong CYP3A4 inhibitors such as ritonavir or itraconazole, more steroid can reach the bloodstream. Keep it away from the eyes, since repeated contact with the eyelids can lead to cataract or glaucoma. Betnovate Cream contains paraffin, so clothing and bedding that have been in contact with it burn more easily: do not smoke or go near naked flames. Check the ingredient list on your own tube.

Itching and local burning or pain on the skin are the common reactions. Very rarely, especially after long or heavy use, there may be thinning of the skin, stretch marks, visible small blood vessels, colour changes, extra hair growth, allergic contact dermatitis or pustular psoriasis. Absorbed steroid can, very rarely, suppress the body's own cortisol and cause Cushing's-type features. Long use can also lead to topical steroid withdrawal reactions, with spreading redness and burning after stopping. Blurred vision should always be reported.

The choice of Betamethasone valerate for your skin, and the length of each course, is for the doctor or prescriber to decide.