Betnovate

Betnovate contains betamethasone valerate. This is a potent topical corticosteroid, which means a strong steroid cream you put on the skin. The BNF (the UK drug guide) places it in potency Group III.

Doctors use it for inflamed skin that has not improved with milder steroids. It calms swelling, eases itching, and narrows small blood vessels in the skin.

It works by binding to receptors inside skin cells. This changes how genes act and lowers the release of chemicals that cause inflammation, such as prostaglandins, leukotrienes, and cytokines.

Betnovate is licensed for eczema (both atopic and discoid), psoriasis (but not widespread plaque psoriasis), contact dermatitis, seborrhoeic dermatitis, lichen planus, lichen simplex, and other steroid-responsive skin conditions.

The cream suits moist or weeping skin. The ointment suits dry, thickened, or scaly skin. NICE and the BNF advise using the weakest steroid that works, for the shortest time you can.

Doctors usually keep Betnovate for moderate to severe inflamed skin after milder creams, such as hydrocortisone or clobetasone, have not helped enough.

Put a thin layer on the affected skin once or twice a day. Use the smallest amount that covers the area. The fingertip unit (FTU) system can guide you. One FTU is about 0.5 g.

It is the amount squeezed from the tip to the first crease of an adult index finger. One FTU covers an area about the size of two adult palms. Rub it in gently until the skin absorbs it.

Do not put it on broken or infected skin unless your prescriber tells you to. If you also use an emollient (a moisturiser), put the emollient on first and wait at least 30 minutes before Betnovate.

You can also apply the steroid first and wait 30 minutes before the emollient. Do not cover the treated skin with airtight dressings unless your prescriber says so.

Covering the skin raises absorption and the risk of side effects.

Put a thin layer on once or twice a day. Keep treatment short. Acute flares usually need 7-14 days. Do not use it without a break for more than 4 weeks unless a specialist reviews you.

On the face, do not use it for more than 5 days, and avoid it where you can in favour of milder creams. In children, use the lowest amount that works for the shortest time, and avoid long-term use.

The 0.1% strength is the standard one. A milder version (Betnovate-RD, 0.025%) is available for less severe skin or sensitive areas. There is no set dose change for different patients.

Take extra care in elderly people with thin skin and on areas that absorb more, such as the armpits, groin, and eyelids.

These side effects come from the SmPC frequency groups and from skin specialist literature.

Common (≥1/100 to <1/10): Burning or stinging where you apply it (this usually passes), skin irritation, and itching at the site.

Uncommon (≥1/1,000 to <1/100): Skin thinning (atrophy), stretch marks (striae, which do not go away), thread veins (telangiectasia), contact dermatitis, loss of skin colour, and extra hair growth (hypertrichosis).

Rare (≥1/10,000 to <1/1,000): Suppression of the HPA axis, the system that controls your stress hormones (this happens with long or widespread use), signs of Cushing's syndrome, high blood sugar (hyperglycaemia), sugar in the urine (glucosuria), perioral dermatitis, acne-like spots, and bacterial or fungal infection of the treated skin.

Skin thinning and stretch marks are the most important local side effects.

They are more likely with long use, airtight dressings, and use on thin-skinned areas such as the face, skin folds, and genitals. These changes may not go away.

Do not use Betnovate on the face for longer than 5 days unless a skin specialist supervises you. Facial skin thins easily and can develop thread veins.

Do not put it on your eyelids, as this can lead to glaucoma and cataracts in the eyes. Long or widespread use raises the chance that the steroid passes into the body.

This is more likely under airtight dressings or on large areas, and it can suppress the HPA axis, the system that controls stress hormones, especially in children.

The MHRA has warned about topical steroid withdrawal reactions. These are burning, stinging, and redness when you stop after long use.

After long courses, reduce the steroid slowly rather than stopping all at once. Do not use it as a moisturiser. Infected eczema also needs the right antimicrobial treatment at the same time.

Psoriasis can flare again or turn into a pustular form if you stop the steroid suddenly.

Do not use Betnovate on untreated skin infections caused by bacteria, viruses (such as herpes simplex or chickenpox), or fungi.

Do not use it for rosacea, acne (acne vulgaris), perioral dermatitis, or widespread plaque psoriasis. Do not use it if you are allergic to betamethasone valerate or any other ingredient.

Do not use it on children under 1 year of age. Avoid it on ulcerated or very thin skin.