Usage
- This combination medication is primarily prescribed for the topical treatment of inflammatory skin conditions like eczema and psoriasis.
- Pharmacological Classification: This is a combination product containing a corticosteroid (anti-inflammatory), keratolytics, and a probiotic. More specifically:
- Betamethasone: Corticosteroid, anti-inflammatory agent
- Salicylic acid: Keratolytic agent
- Sodium lactate and Urea: Humectants, emollients
- Lactobacillus rhamnosus: Probiotic
- Mechanism of Action: Betamethasone reduces inflammation by blocking the production of prostaglandins. Salicylic acid, sodium lactate, and urea work together to soften and exfoliate the skin, aiding in the penetration of betamethasone. Lactobacillus rhamnosus may contribute to restoring the skin’s microbial balance and reducing inflammation.
Alternate Names
- No official alternate names are listed in the sources, but the combination is often referred to by its components.
- Brand Names: Salivate MF, Diprovate MF, Epicort MK.
How It Works
- Pharmacodynamics: Betamethasone binds to glucocorticoid receptors, inhibiting inflammatory pathways. Salicylic acid promotes exfoliation by breaking down keratin. Urea and sodium lactate moisturize by drawing water into the skin. Lactobacillus Rhamnosus potentially supports a healthy skin microbiome.
- Pharmacokinetics: Betamethasone is absorbed through the skin, with potential for systemic absorption, especially with prolonged or high-dose use or application to thin skin or open wounds. Salicylic acid is easily absorbed through the skin. Urea and sodium lactate act locally. The pharmacokinetics of topical Lactobacillus rhamnosus is not well defined, but it likely exerts its effect locally.
- Mode of Action: Betamethasone exerts anti-inflammatory effects through glucocorticoid receptor binding and modulation of gene transcription. Salicylic acid increases skin hydration and dissolves the intercellular cement of the stratum corneum, promoting exfoliation. Urea and Sodium Lactate increases stratum corneum hydration. Lactobacillus Rhamnosus may compete with pathogenic bacteria and modulate immune responses.
- Elimination Pathways: Betamethasone is metabolized in the liver and excreted in urine and bile. Salicylic acid is primarily excreted in the urine, as salicyluric acid, salicylate glucuronides, and unchanged salicylic acid. Urea is primarily eliminated renally. Sodium lactate is metabolized to bicarbonate.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected skin area 1-2 times daily. Do not apply to the face unless specifically directed by a doctor.
Children:
Use with caution in children. Consult a pediatrician for appropriate dosing and duration due to increased risk of systemic absorption. Avoid prolonged use, particularly on the face.
Special Cases:
- Elderly Patients: Use the lowest effective dose for the shortest duration to minimize skin atrophy.
- Patients with Renal Impairment: Caution is advised. Monitor for systemic side effects, especially with prolonged use or high doses.
- Patients with Hepatic Dysfunction: Caution is advised. Monitor for systemic side effects.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, as topical corticosteroids can affect blood glucose control.
Clinical Use Cases
This medication is not typically used in clinical settings such as intubation, surgical procedures, mechanical ventilation, or the ICU. It is exclusively for topical dermatological use.
Dosage Adjustments
Dosage adjustments should be based on the individual’s response, the severity of the condition, and the location of the affected area. Consider renal and hepatic function for appropriate dose adjustments.
Side Effects
Common Side Effects:
- Application site reactions: Burning, itching, irritation, redness, dryness.
Rare but Serious Side Effects:
- Skin atrophy, telangiectasia (spider veins), hypopigmentation, hypertrichosis (increased hair growth), folliculitis, perioral dermatitis, allergic contact dermatitis.
- Systemic absorption can lead to Cushing’s syndrome with prolonged, high-dose, or widespread use, especially in children.
Long-Term Effects:
- Skin thinning, striae (stretch marks), increased risk of skin infections.
Adverse Drug Reactions (ADR):
- Severe allergic reactions: Difficulty breathing, swelling of the face, lips, or tongue, hives.
Contraindications
- Hypersensitivity to any components.
- Viral, bacterial, fungal, or tuberculous skin infections.
- Rosacea, acne, perioral dermatitis.
Drug Interactions
- Other topical medications, especially other topical corticosteroids: Increased risk of local and systemic side effects.
- Oral corticosteroids: Increased risk of systemic side effects.
Pregnancy and Breastfeeding
Topical betamethasone is generally considered safe during pregnancy and breastfeeding when used sparingly on small areas for short periods. However, it’s crucial to consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: Betamethasone: Anti-inflammatory; Salicylic acid: Keratolytic; Urea and sodium lactate: Humectants; Lactobacillus rhamnosus: Improves skin barrier.
- Side Effects: Common: Local skin reactions; Rare: Skin atrophy, telangiectasia, infections; Systemic effects with overuse.
- Contraindications: Hypersensitivity, infections at application site, rosacea, acne.
- Drug Interactions: Other topical or oral corticosteroids.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: Apply a thin layer 1-2 times daily. Avoid prolonged use.
- Monitoring Parameters: Monitor for local skin reactions and signs of systemic absorption (e.g., weight gain, moon face, increased blood glucose).
Popular Combinations
This specific combination is itself a commonly used formulation in dermatology.
Precautions
- Pre-screen patients for allergies and relevant medical conditions.
- Pregnant Women and Breastfeeding Mothers: Consult a doctor before use.
- Children and Elderly: Use with caution and for limited duration.
- Avoid prolonged or excessive use, especially in skin folds and on the face.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Betamethasone + Lacto bacillus Rhamnosus + Salicylic Acid + Sodium Lactate + Urea?
A: Apply a thin layer to the affected area 1-2 times daily. Adjust dosage based on individual response, severity, and affected area. Consult a pediatrician for pediatric dosing.
Q2: Can this combination be used on the face?
A: It should not be applied to the face unless specifically directed by a doctor due to the increased risk of side effects like skin thinning and telangiectasia.
Q3: What are the common side effects?
A: Burning, itching, irritation, redness, and dryness at the application site are common.
Q4: Are there any serious side effects?
A: Rarely, skin atrophy, telangiectasia, and allergic contact dermatitis can occur. Prolonged or excessive use, especially in children or on large areas, can lead to systemic absorption and side effects like Cushing’s syndrome.
Q5: Can this be used during pregnancy or breastfeeding?
A: Consult a doctor before use during pregnancy or breastfeeding. While generally considered safe for limited use on small areas, a risk-benefit assessment should be made.
Q6: What should I do if my symptoms don’t improve?
A: Consult a doctor if your skin condition doesn’t improve after 2-3 weeks of use. Do not continue treatment without medical advice.
Q7: Can I use this combination with other topical medications?
A: Inform your doctor about all other medications you are using, especially other topical corticosteroids or retinoids. Concomitant use can increase the risk of side effects.
Q8: What are the storage recommendations?
A: Store at room temperature away from excessive heat and moisture. Keep out of reach of children.
Q9: What if I accidentally apply too much?
A: Wash the affected area with mild soap and water. Contact a doctor if you develop any concerning symptoms or are unsure about what to do.
