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Betnovate cream, ointment, and lotion

Betnovate is a potent steroid for once or twice daily treatment to moderately severe eczema, on the body, arms, and legs. It is manufactured by GlaxoSmithKline and contains the active ingredient betamethasone. Branded Betnovate and generic betamethasone are both available from Dr Fox as a cream, ointment, or lotion.

Betnovate for the scalp

Betamethasone is also available in several lotion forms for use on scalp eczema. Dr Fox offers two Betnovate branded scalp products - Betnovate lotion and Betnovate scalp which contain betamethasone 0.122%, and two other scalp products: Betacap - 0.1% betamethasone; and Diprosone lotion - 0.05% betamethasone.

About eczema

Eczema is a condition with areas of dry inflamed skin. Inflammation and loss of natural skin oils causes drying out of the skin. Dry skin is not an effective barrier at keeping toxins and irritants out of the body. This then leads to further inflammation and a cycle of drying, inflammation, and more drying.

Treating eczema on the body, arms, and legs

Eczema on the body, arms, and legs is best treated with frequent use of moisturising emollients, but in most cases there will be a time when this is not enough to control the sore inflamed skin. Adding a steroid (cream, ointment, or lotion) like Betnovate will reduce the skin inflammation and enable you to regain control. Betnovate should be used if the eczema is moderate or moderately severe.

How to use Betnovate on the body, arms, and legs

Betnovate should be applied once or twice a day, using it less frequently once skin begins to get better. Moisturising emollients should be continued whilst using Betnovate. Apply your usual emollient and wait at least 15 minutes before applying the Betnovate. Apply a thin amount of Betnovate being guided by the fingertip units for the area affected. Wash hands after use.

Moisturising emollients (lotions, creams, and ointments) restore softening oils to the skin, and rehydrate it. Ointments have a stronger protective barrier effect, so Betnovate ointment is more effective than Betnovate cream. The ointment can feel greasier and look shiny on the skin and so may be better used at night.

Use the Betnovate cream or ointment until the eczema has completely settled. This may only take a couple of days, or a bit longer, but do not use for more than 4 weeks at a time.

Once the eczema has settled, continue frequent moisturising emollient use to reduce the risk of a flare-up and the need to use Betnovate cream or ointment again.

Do not use more Betnovate, or apply for longer than recommended as this increases the risk of side effects.

How to use betamethasone scalp products

Itching scalp eczema can be treated with a once or twice daily lotion of betamethasone to the inflamed scalp skin. The lotion should be applied to the clean and dry scalp, and massaged into the affected skin. It is usually easiest to part the hair in stages and massage the lotion into the skin down the parting. This is easier with an assistant. Wash hands after use.

The following video relates to similar products being used for psoriasis, but shows the lotion application technique clearly (from 49 seconds):

Video from Guy's and St Thomas' NHS Foundation Trust.

Cautions and side effects

Betnovate is too strong to use on the face. It should only be used on eczema on the torso, arms, legs, and scalp.

Betnovate cream, ointment, and lotion contain paraffin which is flammable. The paraffin may be absorbed on clothing and bedding, which should be washed regularly to reduce fire risk. Keep away from naked flames.

Betnovate scalp, Betacap lotion, and Diprosone lotion do not contain paraffin. However, the manufacturers still recommend care around use as they are also flammable. It is advised not to blow-dry hair after these products have been used on the scalp.

Rarely other ingredients in Betnovate may cause skin reactions. If eczema worsens when using Betnovate, stop the treatment and consult your GP or skin specialist.

Overusing Betnovate/betamethasone on the skin may cause skin thinning and stretch marks. This is much more of a problem if using steroids as tablets or injections for conditions other than eczema. Betnovate should be used for the shortest time necessary to control the eczema and not for longer than 4 weeks at a time. If eczema is not settling consult your GP or skin specialist.

Steroid tablet use has been linked with development of cataracts and other problems in the eyes. This is extremely unlikely with Betnovate but if you develop any blurring of vision consult your GP.

Covering the skin after applying treatment, with bandages or gloves is not recommended as in theory it can lead to absorption into the body and more general side effects, including in extreme cases, Cushing's syndrome.

Further information on side effects can be found in the manufacturer's patient leaflets.

When NOT to use Betnovate/betamethasone

Do not use Betnovate/betamethasone cream, ointment, or betamethasone lotions if:

• Eczema is on the face.
• You have not had a medical diagnosis of eczema.
• There are signs of infected skin: pus, weeping, swollen, tender, throbbing, spreading redness.
• You have active cold sores, herpes, shingles, or chickenpox.
• On broken skin or near active leg ulcers.

Pregnancy and breastfeeding

It is recommended to avoid all medicines when pregnant or breastfeeding. However, it is probably safe to use small amounts of Betnovate/betamethasone cream, ointment, or lotion on eczema during pregnancy, or when breastfeeding (but not on the breasts).

Discuss first with your GP. Dr Fox does not prescribe for women who are pregnant or breastfeeding.

See also Best use of medicines in pregnancy - Corticosteroids.