What is the comparison between topical mometasone (corticosteroid) and topical beclomethasone (corticosteroid) for treating inflammatory skin conditions?

Comparison of Topical Mometasone vs Topical Beclomethasone

Mometasone furoate is the superior choice over beclomethasone for inflammatory skin conditions, offering comparable or better efficacy with once-daily dosing, lower systemic absorption (0.7% bioavailability), and reduced risk of HPA axis suppression. 1, 2

Potency Classification

• Mometasone furoate 0.1% is classified as a medium-potency (Class IV) topical corticosteroid with strong anti-inflammatory activity 3, 1
• Mometasone is a synthetic 16-alpha-methyl analogue of beclomethasone, specifically engineered to enhance topical potency while minimizing systemic effects 2
• The vasoconstrictor assay demonstrates strong blanching effects, confirming high topical bioavailability of the active ingredient 4

Efficacy Comparison

Atopic Dermatitis & Eczema

• Mometasone 0.1% once daily produces equivalent results to betamethasone dipropionate 0.05% twice daily over 2-3 weeks 2
• In direct comparison, mometasone 0.1% once daily achieved 93.6% improvement versus betamethasone valerate 0.1% twice daily at 96.5% improvement after 21 days—clinically equivalent outcomes with half the application frequency 5
• Mometasone significantly outperforms lower-potency agents including hydrocortisone 1.0%, clobetasone 0.05%, and hydrocortisone butyrate 2

Psoriasis

• For plaque psoriasis, mometasone demonstrates superior efficacy compared to betamethasone valerate 0.1%, fluocinolone acetonide 0.025%, and triamcinolone acetonide 0.1% 2
• The psoriasis plaque test shows strong antipsoriatic effects with nearly identical reduction in mean infiltrate thickness compared to fatty cream formulations 4
• Mometasone is effective for scalp psoriasis when applied once daily for 2-8 weeks 2

Seborrheic Dermatitis

• Mometasone 0.1% proves more effective than ketoconazole 2.0% and hydrocortisone 1.0% in 4-6 week trials 2

Safety Profile

Systemic Absorption

• Mometasone has minimal percutaneous absorption at approximately 0.7% of applied dose entering circulation after 8 hours on normal skin without occlusion 1
• This represents approximately half the HPA axis suppression potential of betamethasone valerate 2, 6

Skin Atrophy Risk

• Mometasone and betamethasone-17-valerate decrease collagen synthesis to similar extents in human skin, indicating comparable atrophogenic potential within the same potency class 7
• The atrophogenic potential is low and no greater than other glucocorticoids in its class 2

Pediatric Considerations

• In pediatric patients ages 6-23 months with atopic dermatitis, approximately 29% showed adrenal suppression when mometasone was applied once daily over mean body surface area of 40% for 3 weeks 1
• Follow-up testing 2-4 weeks after stopping treatment showed recovery in most patients, with only 1 of 8 tested patients demonstrating persistent suppression 1

Dosing Advantages

• Mometasone requires only once-daily application versus twice-daily for most comparator steroids, improving adherence while maintaining equivalent efficacy 2, 5
• For maintenance therapy in eczema, mometasone applied twice weekly to previously affected areas for up to 36 weeks achieves 68% remission rate 3
• Alternate-day application maintains symptom control in psoriasis vulgaris patients 2

Formulation Options

• Available as 0.1% cream, ointment, and lotion formulations for different clinical scenarios 1, 2
• The light cream formulation (O/W 60/40 emulsion) is particularly suitable for acutely inflamed and sensitive skin 4

Common Pitfalls to Avoid

• Do not use on face, intertriginous areas, or areas susceptible to steroid atrophy without careful monitoring 8
• Avoid occlusive dressings beyond 24 hours, as 96-hour occlusion markedly enhances penetration and systemic absorption 1
• Reassess after 2-4 weeks to determine if continued treatment is necessary and consider step-down to lower potency agents once control is achieved 8

Clinical Bottom Line

Mometasone furoate 0.1% once daily is the preferred agent over beclomethasone-derived products for most inflammatory dermatoses, offering superior convenience, comparable efficacy to higher-frequency betamethasone regimens, and a favorable safety profile with low systemic bioavailability. 1, 2, 5