Should Beta Derm (betamethasone) be avoided in the presence of an active infection?

From the Guidelines

Beta Derm (betamethasone) should be avoided in the presence of an active infection. The use of immunosuppressive therapies, such as betamethasone, can be problematic in the setting of an active infection, as it can worsen the infection or mask its symptoms 1. Betamethasone is a potent topical corticosteroid that suppresses the immune system and reduces inflammation, which can be detrimental when an active infection is present.

Some key considerations when using betamethasone in the context of an active infection include:

• Discontinuing other immunosuppressive therapies to minimize the risk of exacerbating the infection 1
• Avoiding the use of drugs that could slow heart rate or AV conduction, as this can further compromise the patient's health
• Treating the active infection with appropriate antimicrobial therapy before considering betamethasone use
• Potentially using a combination product containing both an antimicrobial agent and a corticosteroid under medical supervision, if both inflammation and infection are present

It is essential to prioritize treating the active infection first, using antimicrobial therapy as needed, before considering the use of betamethasone or any other topical corticosteroid. Healthcare providers should be informed about any signs of infection before using betamethasone to ensure safe and effective treatment.

From the FDA Drug Label

If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled

• Active infection is a condition where the use of Beta Derm (betamethasone) should be approached with caution.
• The drug label recommends that in the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted.
• It is advised to discontinue the corticosteroid until the infection has been adequately controlled if a favorable response does not occur promptly.
• Therefore, Beta Derm (betamethasone) should be avoided or used with caution in the presence of an active infection, and an appropriate antifungal or antibacterial agent should be used to control the infection first 2.

From the Research

Use of Beta Derm in Active Infections

• The use of Beta Derm (betamethasone) in the presence of an active infection is a topic of consideration due to its potential to increase susceptibility to bacterial and fungal infections 3.
• Topical corticosteroids, including Beta Derm, are known for their anti-inflammatory effects but may not be suitable for use when infection is the known cause of the disease 3.
• In cases of atopic dermatitis, the role of Staphylococcus aureus and the use of combined antistaphylococcal and corticosteroid therapy is uncertain, and there is conflicting evidence regarding the effect of antistaphylococcal therapy in atopic dermatitis that is not overtly infected 4.
• Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be effective in flexural eruptions and secondarily infected dermatoses, but caution is advised due to the risk of sensitization and the emergence of resistant strains of bacteria 5.

Precautions and Considerations

• The use of topical corticosteroids, including Beta Derm, requires careful consideration of the risks and benefits, particularly in patient populations at high risk, such as children and those with liver failure 3, 5.
• Certain anatomical sites, such as the flexures and face, are more prone to side effects, and mild or moderate compounds should be used in preference to stronger preparations 5.
• The addition of a corticosteroid to local antifungal therapy may be of value in reducing local inflammatory reaction, but requires caution due to potential risks, especially with long-term use under occlusive conditions 6.

Specific Guidelines for Use

• Combination products containing a low potency nonfluorinated corticosteroid may be used for symptomatic inflamed lesions of tinea pedis, tinea corporis, and tinea cruris in otherwise healthy adults with good compliance, but therapy should be substituted by a pure antifungal agent once symptoms are relieved 6.
• Contraindications for the use of these combinations include application on diaper or other occluded areas and facial lesions, as well as in children <12 years of age and in immunosuppressed patients for any reason 6.