Betnovate

Betnovate contains betamethasone valerate, a potent topical corticosteroid (Group III in the BNF potency classification) used to treat inflammatory skin conditions that have not responded to milder corticosteroids.

It exerts anti-inflammatory, antipruritic, and vasoconstrictive effects by binding to intracellular glucocorticoid receptors, modulating gene transcription, and suppressing the release of inflammatory mediators including prostaglandins, leukotrienes, and cytokines.

Betnovate is licensed for the treatment of eczema (atopic and discoid), psoriasis (excluding widespread plaque psoriasis), contact dermatitis, seborrhoeic dermatitis, lichen planus, lichen simplex, and other steroid-responsive dermatoses.

The cream formulation is suitable for moist or weeping lesions, while the ointment is preferred for dry, lichenified, or scaly skin.

NICE and the BNF recommend using the least potent corticosteroid effective for the condition, applied for the shortest duration possible.

Betnovate is typically reserved for moderate-to-severe inflammatory skin disease after milder preparations (hydrocortisone, clobetasone) have proven inadequate.

Apply a thin layer to the affected area once or twice daily. Use the minimum amount needed to cover the affected area — the fingertip unit (FTU) system provides guidance: one FTU (approximately 0.

5 g, from the tip to the first crease of an adult index finger) covers an area roughly equivalent to two adult palms. Gently massage into the skin until absorbed.

Do not apply to broken or infected skin unless directed.

If an emollient is also prescribed, apply the emollient first and wait at least 30 minutes before applying Betnovate, or apply the corticosteroid first and wait 30 minutes before the emollient.

Do not cover the treated area with airtight dressings unless directed by your prescriber, as occlusion increases absorption and the risk of side effects.

Apply a thin layer once or twice daily. Treatment duration should be limited — typically 7-14 days for acute flares, with a maximum of 4 weeks for continuous use without specialist review.

On the face, use should not exceed 5 days and is generally discouraged in favour of milder preparations. In children, use the lowest effective amount for the shortest duration; avoid prolonged use.

The 0.1% formulation is the standard potency; a milder preparation (Betnovate-RD, 0.025%) is available for less severe conditions or sensitive areas.

No formal dose adjustment exists, but greater caution is needed in elderly patients with thin skin and in areas with high absorption (axillae, groin, eyelids).

Side effects per SmPC frequency categories and dermatological literature.

Common (≥1/100 to <1/10): Local burning or stinging on application (usually transient), skin irritation, pruritus at application site.

Uncommon (≥1/1,000 to <1/100): Skin thinning (atrophy), striae (stretch marks — irreversible), telangiectasia, contact dermatitis, skin depigmentation, hypertrichosis.

Rare (≥1/10,000 to <1/1,000): Hypothalamic-pituitary-adrenal (HPA) axis suppression (with prolonged or widespread application), Cushing's syndrome features, hyperglycaemia, glucosuria, perioral dermatitis, acneiform eruptions, secondary infection (bacterial or fungal) of treated areas.

Skin atrophy and striae are the most clinically significant local adverse effects and are more likely with prolonged use, occlusive dressings, and application to thin-skinned areas (face, flexures, genitalia).

These changes may be irreversible.

Do not use Betnovate on the face for longer than 5 days unless under dermatological supervision, as facial skin is particularly susceptible to atrophy and telangiectasia.

Avoid application to eyelids due to the risk of glaucoma and cataract formation.

Prolonged or widespread use, particularly under occlusion or on large body surface areas, increases systemic absorption and the risk of HPA axis suppression, especially in children.

The MHRA has issued guidance on topical corticosteroid withdrawal reactions (burning, stinging, erythema on discontinuation after prolonged use); taper gradually rather than stopping abruptly after extended courses.

Do not use as a moisturiser. Infected eczema requires concurrent appropriate antimicrobial treatment. Psoriasis may rebound or develop pustular forms on abrupt corticosteroid withdrawal.

Betnovate is contraindicated in untreated bacterial, viral (herpes simplex, varicella), or fungal skin infections, rosacea, acne vulgaris, perioral dermatitis, widespread plaque psoriasis, and hypersensitivity to betamethasone valerate or any excipient.

It should not be used on children under 1 year of age. Application to ulcerated or severely thinned skin is not recommended.