In which diseases are betamethasone (corticosteroid) dipropionate or mometasone (corticosteroid) furoate used?

Clinical Uses of Betamethasone Dipropionate and Mometasone Furoate

Primary Indications

Both betamethasone dipropionate and mometasone furoate are topical corticosteroids used to treat inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, with psoriasis and atopic dermatitis being the most common conditions. 1, 2

Psoriasis

• The combination of calcipotriene and betamethasone dipropionate is the best medication for treating psoriasis, providing superior efficacy compared to either agent alone with a good safety profile for up to 52 weeks 1
• For mild to moderate psoriasis, calcipotriene 0.005% plus betamethasone dipropionate 0.064% is the most effective combination with strong evidence (Grade A recommendation), achieving clear or almost clear status in 69-74% of patients versus 27% with vehicle control 1
• For scalp psoriasis, calcipotriene plus betamethasone dipropionate gel is recommended for 4-12 weeks (Grade A recommendation) 1
• For nail psoriasis, vitamin D analogs combined with betamethasone dipropionate reduce nail thickness, hyperkeratosis, onycholysis, and pain 1
• Mometasone furoate 0.1% applied once daily has shown superior or equivalent efficacy to betamethasone dipropionate 0.05% applied twice daily in psoriasis treatment 3

Atopic Dermatitis (Eczema)

• Mometasone furoate is indicated for corticosteroid-responsive dermatoses in patients ≥12 years of age 2
• In atopic dermatitis patients, mometasone 0.1% applied once daily over 2-3 weeks showed similar effects to betamethasone dipropionate 0.05% twice daily 4
• Medium potency topical corticosteroids (including mometasone) used twice weekly as maintenance therapy are strongly recommended to reduce disease flares and relapse in atopic dermatitis 5
• In pediatric atopic dermatitis patients ages 2-12 years, the majority cleared within 3 weeks with mometasone furoate cream 0.1% once daily 6

Other Dermatological Conditions

• Seborrheic dermatitis: Mometasone 0.1% was more effective than ketoconazole 2.0% and hydrocortisone 1.0% in trials lasting 4-6 weeks 4
• Allergic contact dermatitis: Both agents demonstrated rapid improvement, with average improvements of 38-39% after 3 days and 94-97% after 21 days 7
• Other steroid-responsive dermatoses: Both medications are effective for various inflammatory skin conditions requiring corticosteroid therapy 8, 7

Treatment Algorithms and Strategies

Acute Treatment Phase

• Apply betamethasone dipropionate combined with calcipotriene once daily for optimal efficacy and compliance in psoriasis 1
• Initial treatment duration is 2-3 weeks for acute flares of eczema or psoriasis 5
• Betamethasone valerate foam demonstrated 72% improvement rates when used for 4 weeks for psoriasis 5

Steroid-Sparing Maintenance Strategy

To minimize long-term corticosteroid risks, follow this three-phase approach: 1

1. Initial phase: Betamethasone dipropionate + calcipotriene twice daily
2. Transition phase: Weekend-only betamethasone with 5-day/week vitamin D analog
3. Maintenance phase: Mometasone furoate once daily or alternate-day application

• Intermittent "weekend therapy" (twice weekly application) is recommended as maintenance after achieving initial disease control 5
• Gradual reduction in frequency following clinical response rather than abrupt cessation prevents disease rebound 5

Severe Psoriasis (>10% Body Surface Area)

• Systemic biologic therapy is first-line treatment, with topical therapies used as adjunctive therapy 1
• Add ultrahigh potency (class 1) topical corticosteroid for 12 weeks to biologics to accelerate clearance and target residual plaques (Grade A recommendation) 1
• Calcipotriene/betamethasone dipropionate can be added to biologics to accelerate plaque clearance (Grade B recommendation) 1

Potency Classification and Site-Specific Selection

• Betamethasone dipropionate 0.05% is classified as high-potency (Class III) in standard formulation, equivalent to mometasone furoate 0.1% 3
• Mometasone furoate 0.1% is classified as high-potency (Class III) by the American Academy of Dermatology 3
• Betamethasone dipropionate potentiated 0.05% is classified as super-potent (Class I-II) 3

Site-Specific Considerations

• Do not use high-potency betamethasone dipropionate on face or intertriginous areas where mometasone would be safer 1
• For facial psoriasis, calcipotriene combined with hydrocortisone (not betamethasone dipropionate) is recommended for 8 weeks (Grade B recommendation) 1

Safety Profile and Comparative Advantages

Mometasone Furoate Advantages

• Mometasone furoate demonstrates superior anti-inflammatory activity and longer duration of action compared to betamethasone, with a better safety profile 3
• Mometasone presents less cutaneous atrophy compared to betamethasone dipropionate 3
• Less skin atrophy was observed with mometasone furoate, with slight evidence not appearing before 4-12 weeks of treatment, compared to betamethasone dipropionate 8
• Approximately 0.4% of the applied dose enters circulation after 8 hours on normal skin without occlusion 6

Common Adverse Effects

• Local adverse reactions include burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration, secondary infections, skin atrophy, striae, and miliaria 9
• Systemic absorption can produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria 9
• In pediatric patients ages 6-23 months with atopic dermatitis, approximately 16% who showed normal adrenal function before treatment developed adrenal suppression after 3 weeks of mometasone furoate cream 0.1% application over a mean body surface area of 41% 6

Critical Pitfalls to Avoid

• Do not assume "tachyphylaxis" - perceived treatment failure is usually due to poor adherence, not receptor down-regulation 1
• Avoid continuous use beyond 2-4 weeks due to increased risk of skin atrophy, telangiectasia, striae, and other local cutaneous side effects 5
• Do not use topical therapy alone for severe whole-body psoriasis (>10% body surface area), as this is inadequate and delays appropriate systemic treatment 1
• Always combine with regular emollients (applied at separate times) to enhance efficacy and reduce total steroid requirements 5

Monitoring Requirements

• Monitor for signs of skin thinning, telangiectasia, and striae development during treatment 5
• HPA axis suppression can occur with prolonged continuous use on large surface areas, particularly when combined with other corticosteroid forms 5
• Risk factors for adverse effects include prolonged continuous use, application to thinner skin areas, occlusion, and older patient age 5