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Potent topical corticosteroid Pregnancy: Use with caution; use smallest amount on smallest area for shortest time.

Betamethasone Valerate

Brand names: Betnovate, Bettamousse

Adult dose

Dose: Apply thinly once or twice daily
Route: Topical (cream, ointment, lotion, or scalp application)
Frequency: Once or twice daily; reduce to once daily or less as condition improves
Max: 30 g/week (body); 60 g/week (scalp)
0.1% cream/ointment (potent). Apply thin layer to affected areas. Use fingertip unit (FTU) guide: 1 FTU ≈ 0.5 g. Limit continuous use on face to 5–7 days; 4 weeks on body. Avoid eyes, mucous membranes. Betamethasone valerate 0.025% (dilute, moderately potent) for thin skin/face.

Paediatric dose

Route: Topical
Frequency: Once daily
Max: 7.5 g/week (children 1–4 years); 15 g/week (5–12 years)
Children: once daily only. Avoid prolonged use on face, flexures, nappy area. Use finger-tip unit (FTU) guidance. In neonates/infants — use only mild to moderate potency corticosteroids. Betamethasone valerate 0.1% is potent — use with caution and sparingly in children.

Dose adjustments

Renal

No systemic dose adjustment for topical use.

Hepatic

No systemic dose adjustment for topical use.

Clinical pearls

  • Fingertip unit (FTU): 1 FTU from fingertip to first crease ≈ 0.5 g — covers area of two adult hands
  • Taper on recovery — do not stop abruptly (rebound)
  • Potency ladder: mild (hydrocortisone 1%) → moderate (clobetasone 0.05%) → potent (betamethasone 0.1%) → very potent (clobetasol 0.05%)
  • Avoid occlusion of potent steroids except under specialist guidance
  • Step down to milder steroid or emollient as condition improves

Contraindications

  • Untreated skin infections (bacterial, viral, fungal, parasitic)
  • Rosacea
  • Perioral dermatitis
  • Acne vulgaris
  • Skin atrophy

Side effects

  • Skin thinning and atrophy
  • Striae (stretch marks — irreversible)
  • Telangiectasia
  • Delayed wound healing
  • HPA axis suppression (with extensive use, occlusion, or in children)
  • Perioral dermatitis (facial overuse)
  • Secondary infection

Interactions

  • Systemic absorption increases with occlusion

Monitoring

  • Skin integrity
  • Signs of infection
  • HPA axis suppression (extensive or prolonged use)

Reference: BNFc; BNF; NICE CG57 Atopic Eczema; British Association of Dermatologists Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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