Betnovate C (Betamethasone Valerate 0.1% with Clioquinol) for Eczema or Psoriasis
Apply Betnovate C (betamethasone valerate 0.1% with clioquinol 3%) as a thin film 1-3 times daily for 2-4 weeks maximum, then taper to twice-weekly maintenance therapy rather than stopping abruptly, and always combine with regular emollients applied at separate times. 1, 2
Initial Treatment Phase
Apply 1-3 times daily for acute flares, with once or twice daily often being effective for most patients 2. The optimal acute treatment duration is 2-4 weeks to balance efficacy with safety 1. For eczema specifically, twice-daily application provides faster symptomatic relief compared to once-daily, though final outcomes are similar 3.
- Betamethasone valerate demonstrates 72% improvement rates when used for 4 weeks in psoriasis 1
- Apply as a thin film to affected areas only, avoiding perilesional skin 2
- The combination product (Betnovate-C) contains clioquinol 3%, which provides antimicrobial coverage useful when secondary infection is suspected 4
Critical Safety Warnings
Never use potent topical steroids like betamethasone over large psoriatic areas for extended periods - this can trigger life-threatening generalized pustular psoriasis through systemic absorption 5. Patients absorbed at least 1.5 mg betamethasone daily when applied extensively, equivalent to 3 oral steroid tablets 5.
Specific Contraindications and Precautions:
- Avoid continuous use beyond 2-4 weeks due to risk of skin atrophy, telangiectasia, striae, and HPA axis suppression 1, 4
- Do not use on facial or intertriginous areas without dermatology supervision - these sensitive sites require lower potency alternatives 4
- Maximum monthly dose: 100g of moderately potent preparations without dermatological supervision 4
- Monitor for tachyphylaxis (decreased effectiveness) with prolonged continuous use 4, 1
Tapering and Maintenance Strategy
After achieving initial control (2-4 weeks), transition to intermittent "weekend therapy" - apply twice weekly (e.g., Saturday and Sunday) as maintenance rather than stopping abruptly 1. This approach:
- Prevents rebound flares that occur with abrupt discontinuation 1
- Reduces cumulative steroid exposure and adverse effects 4
- Maintains disease control in chronic conditions 1
Incorporate periods each year using alternative non-steroidal treatments such as coal tar, vitamin D analogues (calcipotriene), or emollients alone 4.
Combination Therapy Optimization
Always prescribe regular emollients to be applied at separate times from the steroid - this enhances efficacy while reducing total steroid requirements 4, 1. For psoriasis specifically:
- Consider alternating with vitamin D analogues (calcipotriene) to achieve steroid-sparing effect 4
- Shift to weekend-only betamethasone while maintaining weekday vitamin D analogue therapy once controlled 4
- Coal tar (0.5-10% crude coal tar in petroleum jelly) is extremely safe for long-term use and can alternate with steroids 4
Body Site-Specific Guidance
For body/trunk/extremities: Betamethasone valerate 0.1% is appropriate as a moderately potent (BNF Grade III) preparation 4
For face/flexures/genitalia: Use lower potency alternatives (1-2.5% hydrocortisone or eumovate) instead 4. Betamethasone is too potent for these thin-skinned areas 4.
For scalp: Betamethasone lotion formulation is preferred - apply a few drops and massage until absorbed, twice daily initially 2
Monitoring Requirements
Mandatory clinical review schedule - no unsupervised repeat prescriptions should be issued 4. Monitor for:
- Skin atrophy, telangiectasia, or striae development 1
- Signs of secondary infection requiring antimicrobial therapy 4
- Disease progression requiring dermatology referral 4
- HPA axis suppression if used on large surface areas 1, 4
When to Refer to Dermatology
Immediate dermatology supervision required for: