Betamethasone Valerate

Betamethasone Valerate is a synthetic corticosteroid ester that, applied to the skin, reduces inflammation, itching and the overproduction of skin cells. At 0.1% it is classed as a potent steroid, stronger than mild hydrocortisone and moderately potent clobetasone butyrate, but weaker than very potent clobetasol propionate. The UK SmPC lists steroid-responsive skin conditions such as atopic and discoid eczema, prurigo nodularis, psoriasis other than widespread plaque psoriasis, lichen simplex chronicus, lichen planus, seborrhoeic dermatitis, contact sensitivity reactions, discoid lupus erythematosus, reactions to insect bites and prickly heat.

This listing covers a single strength, 0.1% cream, supplied as 1, 3, 5, 7, 9 or 12 tubes. A cream base suits moist or weeping areas and skin folds, as it is light and rubs in without leaving a greasy film. For very dry, thickened or scaly patches an ointment is often preferred, and a weaker 0.025% preparation exists for when the skin has improved and a gentler steroid is enough.

Smooth a thin layer of Betamethasone Valerate over the affected skin once or twice a day and rub it in gently. The fingertip unit is a handy guide: the amount squeezed from the tip of an adult finger to the first crease covers an area about the size of two adult palms. Once the skin is under control, applications are reduced, for example to once a day or a few times a week, or a milder steroid is used instead. If there is no improvement within two to four weeks, the diagnosis and treatment need reviewing. Wash your hands afterwards unless the hands themselves are being treated, and leave a gap, often about half an hour, between the steroid and an emollient. Do not cover the area with a dressing or cling film unless told to.

In the UK the 0.1% cream is a prescription-only medicine (POM). The established brand is Betnovate, and generic versions are also licensed. Combination products with antibiotics or antifungals exist for infected eczema, but they are separate medicines. Whether a potent steroid is suitable, where on the body and for how long, is decided by the doctor or prescriber.

Avoid it on rosacea, acne and perioral dermatitis, which a steroid can make much worse, and on untreated bacterial, fungal or viral skin infections such as cold sores or chickenpox. It is not used for itching around the anus or genitals without a clear cause, nor for skin conditions in babies under one year. Courses in children and on the face are kept short, as thin skin absorbs more of the medicine. Keep it away from the eyes; prolonged use on the eyelids has been linked with glaucoma and cataract. Large areas, broken skin or occlusion increase the amount absorbed, and medicines that block CYP3A4, such as ritonavir or itraconazole, can raise blood levels further.

Itching, burning or stinging where the cream is applied are the commonest early complaints. With long or heavy use the skin can thin, develop stretch marks, show small visible blood vessels or lose some colour, and acne-like spots or extra hair growth may appear. Absorption into the body is rare with sensible use but, on large areas, can suppress the body’s own cortisol. The MHRA has highlighted topical steroid withdrawal reactions after long-term use of potent steroids, with burning red skin that returns when treatment stops. Blurred vision or other changes in sight should be checked by a doctor, and suspected side effects can be reported through the Yellow Card scheme.