From the Guidelines
Betamethasone valerate 0.05% cream is a recommended treatment for phimosis, with a study showing that 80% of boys had normal retractability of the foreskin after using betamethasone for 1 month 1. The use of betamethasone valerate 0.05% cream for phimosis is supported by evidence from a prospective study of 111 boys with phimosis, which demonstrated significant improvement in foreskin retractability after 1 month of treatment 1.
Key Points to Consider
- The treatment regimen typically involves applying a small amount of the cream to the tight foreskin twice daily for 4-8 weeks.
- Parents or patients should gently retract the foreskin as tolerated during application, without forcing it.
- Improvement is typically seen within 2-4 weeks, but the full course should be completed.
- After successful treatment, regular gentle retraction during bathing helps maintain results.
Mechanism of Action
The effectiveness of betamethasone valerate 0.05% cream in treating phimosis can be attributed to its potent corticosteroid properties, which reduce inflammation and soften the tissue by inhibiting inflammatory mediators and promoting collagen breakdown in the tight preputial ring.
Efficacy and Safety
The non-surgical approach using betamethasone valerate 0.05% cream resolves phimosis in approximately 70-90% of cases, potentially avoiding circumcision 1.
Potential Side Effects and Complications
Side effects are minimal with short-term use but may include local irritation or skin thinning.
Referral to Specialist
If no improvement occurs after 4-8 weeks of consistent application, or if phimosis is severe or causing complications like recurrent infections or urinary problems, referral to a urologist for possible surgical management is recommended.
From the Research
Effectiveness of Betamethasone Valerate 0.05% Cream for Phimosis
- The effectiveness of betamethasone valerate 0.05% cream for phimosis has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2002 found that 74% of boys with phimosis had fully retractable foreskins after 1 month of treatment with 0.05% betamethasone cream, and 18% had a partial response at 1 month, with the prepuce becoming fully retractable during month 2 of therapy 2.
- Another study published in 2006 used 0.07% betamethasone valerate ointment and found an overall success rate of 94.1% and therapeutic effects were observed in 58.8% of the patients in two weeks 3.
- A study published in 2011 compared the efficacy of three different formulations containing Betamethasone Valerate versus placebo in the topical treatment of phimosis, and found that Betamethasone Valerate 0.1%, 0.2% and 0.2% in combination with Hyaluronidase had equally higher results than placebo in the treatment of phimosis in boys from three to ten years-old 4.
- A study published in 2012 found that the success rate for topical steroid cream was 69.4% and 63.9% at 3 and 8.3 months, respectively, and the objectivation of the phimosis grade did not predict the outcome 5.
- A recent study published in 2024 found that topical therapy for true phimosis with betamethasone 0.2% + hyaluronidase, despite showing no differences when compared with betamethasone 0.2% alone, for a period of up to 60 days, proved to be safe, effective, and with good results 6.
Safety and Side Effects
- The studies found that there were no adverse side effects associated with the use of betamethasone valerate cream for phimosis 2, 3, 4, 5, 6.
- One study found that systemic absorption evaluated by salivary cortisol did not show differences after the intervention, indicating that there was no systemic absorption when using ointments with or without hyaluronidase 6.
Treatment Outcomes
- The treatment outcomes for betamethasone valerate 0.05% cream for phimosis vary depending on the study, but overall, the success rates range from 63.9% to 94.1% 2, 3, 4, 5, 6.
- The factors that influence the treatment outcomes, such as age, adherence, balanoposthitis, and previous use of corticosteroids, were found to not have a significant impact on the results 6.