Betamethasoni dipropionas

Local and systemic toxicity is common, particularly with prolonged use over large areas of damaged skin, in skin folds and under polyethylene occlusion. When the product is applied to the face, treatment should not exceed 5 days. General The application site must not be covered with an occlusive dressing. The use of topical corticosteroids may carry a number of risks in patients with psoriasis, including rebound relapse following the development of tolerance, the risk of generalised pustular psoriasis, and local and systemic toxicity due to impairment of the skin barrier. Careful patient monitoring is essential. Systemic absorption of topical steroids may produce reversible suppression of the HPA (hypothalamic–pituitary–adrenal) axis, with the potential for glucocorticosteroid insufficiency on discontinuation of treatment. Some patients exhibiting systemic absorption of topical corticosteroids may also develop features of Cushing's syndrome during treatment. Patients receiving high doses of potent topical steroids over large surface areas should be reviewed regularly for evidence of HPA-axis suppression. If suppression occurs, the product should be withdrawn, the frequency of application reduced, or a less potent corticosteroid substituted. Recovery of HPA-axis function is generally prompt and complete on cessation of treatment. Rarely, steroid withdrawal symptoms may occur, requiring supplementary systemic corticosteroids. Paediatric patients may be more susceptible to systemic toxicity from equivalent doses owing to a greater skin surface-to-body-mass ratio. During topical corticosteroid therapy, account must be taken of the reservoir function of the epidermis, which permits gradual release of corticosteroid accumulated in the stratum corneum following previous application. If irritation of the treated area develops, the product should be discontinued and appropriate treatment instituted. Beloderm is not intended for ophthalmic use. When applied to the eyelids, care should be taken to prevent the preparation from entering the eye, as this may cause glaucoma. Cataract has been reported in the literature in patients receiving long-term corticosteroid therapy. Use in the paediatric population The paediatric population is more susceptible than adults to HPA-axis suppression induced by topical and exogenous corticosteroids and to the effects of exogenous corticosteroids, owing to a greater skin surface-to-body-mass ratio. HPA-axis suppression, Cushing's syndrome and intracranial hypertension have been reported in paediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in paediatric patients include growth retardation, delayed weight gain, low plasma cortisol concentrations and absence of response to ACTH stimulation. Signs of intracranial hypertension include bulging fontanelles, headache and bilateral papilloedema. Visual disturbance Visual disturbance may be reported with both systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, referral to an ophthalmologist should be considered for evaluation of possible causes, which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR), which has been reported following both systemic and topical corticosteroid administration.