Usage
Betamethasone + Chlorocresol + Neomycin is a topical combination medication primarily prescribed for inflammatory skin disorders complicated by bacterial infection. These skin conditions include eczema (atopic, discoid), psoriasis (excluding widespread plaque psoriasis), contact dermatitis, seborrheic dermatitis, insect bite reactions, and intertrigo (anal and genital).
Pharmacological Classification:
- Betamethasone: Corticosteroid (topical)
- Chlorocresol: Antiseptic, preservative
- Neomycin: Aminoglycoside antibiotic
Mechanism of Action:
Betamethasone reduces inflammation, itching, and redness by suppressing the immune response and inhibiting inflammatory mediators. Neomycin combats bacterial infections by inhibiting bacterial protein synthesis. Chlorocresol acts as a preservative, preventing microbial contamination of the cream.
Alternate Names
Betamethasone valerate + Neomycin sulfate + Chlorocresol.
There may be other international and regional name variations. Brand names include Betnovate-N, Betaderm, and others (brand names can vary by region).
How It Works
Pharmacodynamics:
- Betamethasone: Binds to glucocorticoid receptors in the skin, modulating gene expression and reducing inflammatory responses.
- Neomycin: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit.
Pharmacokinetics:
- Absorption: Topical application minimizes systemic absorption. However, some absorption can occur, especially with prolonged use over large areas, broken skin, or under occlusive dressings. Increased absorption is also possible in infants and young children due to their thinner skin and higher skin surface area to body weight ratio.
- Metabolism: Betamethasone is metabolized in the liver.
- Elimination: Both betamethasone and neomycin are primarily excreted by the kidneys. Neomycin is mostly excreted unchanged in urine.
Mode of Action:
Betamethasone, a potent corticosteroid, exerts its anti-inflammatory, antipruritic, and vasoconstrictive effects by binding to glucocorticoid receptors, which then translocate to the nucleus and modify gene transcription. Neomycin, an aminoglycoside antibiotic, binds to the 30S ribosomal subunit of susceptible bacteria, disrupting protein synthesis and leading to bacterial cell death.
Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation:
- Betamethasone: Binds to glucocorticoid receptors.
- Neomycin: Inhibits bacterial protein synthesis by binding to ribosomes.
Elimination Pathways:
- Betamethasone: Primarily renal excretion after hepatic metabolism.
- Neomycin: Primarily renal excretion.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area two to three times daily until improvement is observed, then reduce to once daily or less frequently. Do not use for more than seven days without medical supervision.
Children:
Children aged 2 years and older: Same as adult dosage, but limit treatment to five days, if possible.
Children under 2 years: Not recommended due to increased risk of systemic absorption.
Special Cases:
- Elderly Patients: Suitable for use, but use with caution in patients with decreased renal function.
- Patients with Renal Impairment: Dosage reduction is recommended due to the risk of neomycin accumulation.
- Patients with Hepatic Dysfunction: Use with caution as betamethasone is metabolized in the liver.
- Patients with Comorbid Conditions: No specific dosage adjustments mentioned in the sources. Evaluate on a case-by-case basis.
Clinical Use Cases
The provided sources do not give dosage recommendations for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. This combination is intended for topical skin application, not systemic use.
Dosage Adjustments
Dosage adjustments may be needed based on the patient’s age, the severity of the skin condition, the size of the affected area, and the presence of other medical conditions. Closely monitor patients with renal impairment.
Side Effects
Common Side Effects:
Burning, itching, irritation, dryness, skin atrophy (local).
Rare but Serious Side Effects:
Allergic contact dermatitis, skin hypopigmentation, hypertrichosis, telangiectasia, striae, secondary infections. Systemic absorption can lead to Cushing’s syndrome, hyperglycemia, and adrenal suppression with prolonged use.
Long-Term Effects:
Skin thinning, striae, telangiectasia, and hypopigmentation with prolonged use.
Adverse Drug Reactions (ADR):
Severe allergic reactions.
Contraindications
Hypersensitivity to any components; viral skin infections (e.g., herpes simplex, varicella); fungal skin infections (e.g., ringworm, candidiasis); tuberculosis of the skin; rosacea; acne vulgaris; perioral dermatitis; children under 2 years of age. Perforated eardrum (if used for otitis externa).
Drug Interactions
Concurrent use of other topical medications on the same area should be done with caution. Other topical corticosteroids may increase the risk of side effects. Consult a physician if using other topical medications or if taking oral medications.
Pregnancy and Breastfeeding
Use during pregnancy and breastfeeding is generally not recommended unless the potential benefit outweighs the risk. Neomycin can be systemically absorbed, posing a theoretical risk to the fetus. Consult a physician.
Drug Profile Summary
Please see the preceding sections for detailed information on each aspect.
Popular Combinations
No popular combinations of betamethasone, chlorocresol, and neomycin were identified. However, betamethasone and neomycin are often combined in topical formulations.
Precautions
Please see the preceding sections, especially “Contraindications,” “Drug Interactions,” and “Pregnancy and Breastfeeding.” Avoid prolonged use, use on large areas, occlusive dressings (unless specifically prescribed). Use with caution in children, the elderly, and patients with renal impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Betamethasone + Chlorocresol + Neomycin?
A: Apply a thin layer to the affected area two to three times daily for adults and children 2 years and older. Reduce frequency upon improvement. Do not use for more than 7 days without medical supervision. Children under 2 years: not recommended.
Q2: Can this cream be used on the face?
A: Use on the face should be limited to a maximum of 5 days and avoid using occlusive dressings.
Q3: Can it be used for diaper rash?
A: It is not recommended for diaper rash, particularly in infants due to a higher risk of systemic absorption. Consult a pediatrician.
Q4: What should I do if my condition doesn’t improve after a week?
A: Consult a physician. You may need a different medication or treatment.
Q5: What are the signs of an allergic reaction to this cream?
A: Signs of an allergic reaction may include increased redness, swelling, itching, burning, or a rash spreading beyond the treated area. Stop using the cream and seek medical attention if you experience these symptoms.
Q6: Can this cream be used during pregnancy or while breastfeeding?
A: It is generally not recommended during pregnancy or breastfeeding unless the potential benefits outweigh the risks. Consult a physician for guidance.
Q7: Can I use this cream on open wounds?
A: No, it is not recommended for use on open wounds, burns or ulcerated skin.
Q8: Is it safe to use this cream long-term?
A: Prolonged use should be avoided as it can cause skin thinning, striae, and other side effects, especially with use over large areas or under occlusion. Continuous long-term use can also lead to systemic absorption and related side effects. Consult a physician if the condition persists.
Q9: What should I do if I accidentally get this cream in my eyes?
A: Rinse thoroughly with plenty of water and seek medical advice if irritation persists.
