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Betamethasone Valerate Medicated Plaster Column Vertical lines – object style – width 0.35 – DN Grey Running Header Product REVIEW Headline box does not go smaller, but can go bigger Betamethasone Valerate Medicated Plaster (BMVP) Author name box (not in Ask pharma or News) 2.250 (Betesil®) Product Review Space mg Polly Buchanan Article intro table or text if no table Buchanan P. Betamethasone Valerate Medicated Plaster (BMVP) 2.250 mg (Betesil®) Product Review. Dermatological Nursing 2019. 18(1):42-45 Introduction corticosteroid (betamethasone (elbows, knees, anterior skin of tibia and Managing chronic inflammatory skin valerate 2.250 mg) impregnated into heels) and offers controlled sustained conditions is the mainstay of our an adhesive plaster (Betesil®), which release of betamethasone valerate work in dermatology. Inflammatory is specifically indicated for difficult to 2.250 mg for a period of up to 24 hours. skin conditions such as psoriasis and treat recalcitrant inflammatory skin eczema are so very common with many conditions such as localised chronic What is the clinical evidence? different clinical presentations. Not all psoriasis plaques, eczema, lichenification, The LIBERE study was an open label, persons with a skin condition are eligible granuloma annulare, mycosis fungoides, multicentre, prospective, observational for systemic treatments and therefore lichen planus and palmoplantar study for BMVP in persons with any the fundamentals of management inflammatory lesions.2 inflammatory dermatoses amounting to continue to be appropriate topical less than 5% of the body surface area. corticosteroid therapies which remain Betamethasone Valerate Medicated Plaster - 258 respondents were recruited, the a therapeutic class for inflammatory BMVP (Betesil®) majority of which had psoriasis (49%), dermatological conditions.1 eczema (34%), or other dermatoses What is BMVP (Betesil®)? (17%). Pre and post treatment clinical The art and the science of Betesil® is a licensed product available evaluations included disease severity, management becomes evident when in the UK for the management of using the Physician Global Assessment we, as health professionals, consider inflammatory dermatoses which do (PGA) score, patient satisfaction and what topical treatments are available for not respond to less potent topical Quality of Life using the Dermatology specific conditions and presentations. steroids. The cutaneous effects are due Life Quality Index (DLQI). The BMVP For example, the topical management to the anti-inflammatory, anti-pruritic, one considers for guttate psoriasis may anti-proliferative and vasoconstrictive ® differ to that considered for chronic properties of its active ingredient Betesil can be applied large plaque psoriasis or localised betamethasone valerate.3 once daily to specific plantopustular psoriasis. Similarly, inflammatory lesions, within the ‘eczema’ range, the topical The technically advanced adhesive on not more than 5% treatments suggested for atopic plaster is intended for difficult to treat of total BSA eczema can differ considerably to that areas such as the extensor surfaces of nummular eczema, or seborrheic eczema. In addition, inflammatory skin lesions in difficult to treat areas always represent a clinical challenge for both health professional and patient. This article is a product review of a well-known potent topical Polly Buchanan is a Community Dermatology Nurse Practitioner, NHS Fife, Clinical Editor of Left hand column Author info box aligned bottom Dermatological Nursing and an Independent/ Supplementary Nurse Prescriber 42 Dermatological Nursing, 2019, Vol 18, No 1 www.bdng.org.uk DN February 2019O.indd 42 15/03/2019 16:26 Column Vertical lines – object style – width 0.35 – DN Grey Product REVIEW Running Header Headline box does not go smaller, but can go bigger Author name box (not in Ask pharma or News) Space Article intro table or text if no table Note: This image shows the application of a placebo plaster. For application guidance always refer to the SmPC or PIL. Cutting techniques are available at betesil.co.uk. was applied daily for up to 4 weeks as The flexibility of the plaster to the bioavailability of BMV cream, per manufacturer’s recommendations. with and without occlusion, following Results indicated that betamethasone lends itself to application repeated applications. Results indicated valerate medicated plaster was well- over lesions on skin and that the percutaneous absorption of tolerated and effective in the treatment joints subject to increased BMV from the plaster applications of inflammatory dermatoses, improving movement such as the was noted to be below the limit of clinical signs as well as patients’ quality elbows and knees quantification (0.5 mg/ml) in about of life. The greatest improvement in half of the subjects in that treatment clinical assessment and DLQI reported group. Percutaneous absorption of by respondents was with eczema. BMV were found in any of the blood BMV cream group was below the limit Respondents reported the BMVP was tests of healthy respondents.5 of quantification in all but one subject. more effective than previous therapies Researchers concluded that although (93.5% very satisfied and 90.4% satisfied), Safety of BMVP studies have also the bioavailability of BMV is higher in the and ease of use and rapidity of application been undertaken with persons with plaster application group, levels of active were rated as good or very good.4 psoriasis. Following repeated applications, substance remained very limited.7 blood plasma levels of BMV were An early phase I safety study on deemed to be lower than normal blood A safety and efficacy randomised healthy individuals demonstrated that cortisol levels and therefore too low to controlled trial demonstrated that following repeated BMVP patch tests cause any systemic toxic effects.6 BMVP was more efficacious than BMV over 19 days, whereby the BMVP cream with a statistically significant patches were applied for 24 and 48 Another study explored the difference (p<0.001 versus BMV cream) Left hand column Author info box aligned bottom hours, no detectable concentrations of bioavailability of BMVP as compared in clearance of mild to moderate www.bdng.org.uk Dermatological Nursing, 2019, Vol 18, No 1 43 DN February 2019O.indd 43 15/03/2019 16:26 Column Vertical lines – object style – width 0.35 – DN Grey Running Header Product REVIEW When not to use Betesil®? Betesil® is contraindicated if there Headline box does not go smaller, but can go bigger is any hypersensitivity to the active ingredient or any excipients. Avoid application on any lesions considered to be bacterial, viral or fungal. This includes tuberculosis of the skin, herpes Author name box (not in Ask pharma or News) simplex and herpes zoster. It is also contraindicated for inflammatory Space lesions such as acne, rosacea, perioral dermatitis as well as ulcers, burns and frostbite. Facial use should be avoided. Article intro table or text if no table It should not be used on patients under 18.2 Is Betesil® a high-quality product? plaque psoriasis at 3 weeks, which was published and identified the clinical Betesil® feels like a high-quality product, sustained at 5 weeks. No differences benefits as being increased controlled well packaged, with individual plasters were demonstrated in safety as release and penetration of active contained in individual foil sachets. assessed by reported adverse events.8 ingredient into the area requiring The colourless, translucent plasters are treatment, enhanced skin hydration and flexible and adhere readily to clean A large multicentred, prospective, protection from trauma or scratching.3 dry skin. If using portions of the plaster assessor blinded, randomised controlled at any one time, the residual plaster trial compared BMVP with calcipotriol- Assessment of efficacy for potent can remain within the packaging for betamethasone dipropionate fixed dose BMVP (potent corticosteroid) with subsequent applications. An open foil combination ointment over a 4 week fludroxycortide tape (moderately plaster pack can be used for up to treatment period. 324 patients with potent corticosteroid), and with 1 month before discarding. An unopened psoriasis were recruited. Researchers other potent topical corticosteroid plaster pack has a shelf life of 3 years. concluded that both treatments creams or ointments under occlusion significantly improved patients’ with different dressings would not be Have others had a good experience with psoriasis and Quality of Life. Results relevant comparators, because mode of the product? also demonstrated the BMVP is non- delivery and absorption rates differ. In reviewing the literature and evidence inferior to calcipotriol-betamethasone surrounding BMVP, patient feedback dipropionate fixed dose combination Is the product easy to use? and satisfaction appear to be high, ointment, and significant QOL Betesil® can be applied once daily to with many positive comments in the improvement was also preserved during specific inflammatory lesions, on not literature regarding improving Quality the 8 week follow up period.9 more than 5% of total BSA. The plaster of Life, ease of use, preference over can be cut to shape to fit the lesions greasier creams and ointments, less A small, phase II, single centre, exactly, left in situ for 24 hours, then mess, less staining of clothes. Patient randomised, investigator blinded, ‘within removed prior to bathing or showering preference and choice is always useful patient’ comparator, 4 week study was
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