What is clotrimazole and betamethasone dipropionate cream (Lotrisone) and why is it prescribed?

Table of Content:
What is clotrimazole and betamethasone used for? | Should I use it? | How to get an anti-fungal prescription? | Concerns | Lotrisone alternatives | FAQ

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What is Lotrisone (clotrimazole and betamethasone dipropionate cream) used for?

According to Dr. Ryan Trowbridge, board-certified dermatologist, in many cases, it may be difficult for healthcare providers who do not specialize in dermatology, to differentiate fungal infections from other skin conditions like dermatitis or eczema. Misdiagnosis tends to lead to unnecessary antifungal use for nonfungal conditions or corticosteroid use for fungal rashes.

When the cause of a rash is unclear, healthcare providers may prescribe antifungal-corticosteroid combination creams, but these are often less effective and more expensive than single antifungal treatments and may contribute to antimicrobial-resistant fungal infections¹.

There are some circumstances where the combination of an antifungal and a topical steroid may be justified, but it is very uncommon. One example of such a cream is clotrimazole and betamethasone combination cream, frequently prescribed under the brand, “Lotrisone”. 

“There are a few important considerations with this cream,” says Dr. Trowbridge. “First, the steroid in this preparation (betamethasone dipropionate) is quite potent, especially for the areas where it’s most often applied—typically the groin and genital regions. This can be a concern, particularly with long-term use.”

He continues, “The antifungal component (clotrimazole) is generally effective for yeast infections caused by candida, which can be involved in conditions like intertrigo. However, it’s less effective for other fungal infections such as ringworm, athlete’s foot, or tinea, which are caused by dermatophytes.”

I got a prescription for Lotrisone, should I use it?

Dr. Trowbridge explains that while this medication is commonly prescribed, it can sometimes be a sign that the exact cause of the rash isn’t entirely clear—since it combines a strong steroid with an antifungal, each targeting different issues. “Rashes can be difficult to diagnose, so it’s not unusual for providers to reach for a broad treatment like this,” she says. “That said, it’s a good idea to talk with your doctor about what they’re aiming to treat specifically, and why this particular combination was chosen. There may be a solid reason, but it’s worth making sure you fully understand the treatment plan.”

How to get a prescription for a skin problem?

If you have been prescribed Lotrisone and you would like a second opinion since your rash did not improve with this medication, you can have a photo-consultation with a dermatologist via Miiskin. Our affiliated dermatologists are all board-certified, and have extensive experience diagnosing and prescribing medications via photo-consultations. These experienced skin specialists will make an assessment and will offer adequate treatment.

Concerns about using clotrimazole and betamethasone dipropionate cream to treat fungal or yeast infections

Dr. Trowbridge advises against the routine use of  Lotrisone (clotrimazole and betamethasone dipropionate cream) for the treatment of fungal or yeast infections due to several concerns.

Potency of the steroid component

Betamethasone dipropionate is a high-potency corticosteroid. When applied to sensitive areas like the groin or genitals, especially over extended periods, it can cause side effects such as skin thinning, stretch marks, and hormonal imbalances. These risks are particularly concerning when the medication is used without proper medical supervision.

Limited antifungal spectrum

Clotrimazole is primarily effective against yeast infections caused by Candida species. However, many common skin fungal infections, such as athlete’s foot and ringworm, are caused by dermatophytes, against which clotrimazole is less effective. Therefore, using this combination cream may not adequately address these infections.

Cost considerations

Combination creams like clotrimazole and betamethasone dipropionate are often more expensive than single-agent antifungal treatments. 

Risk of antifungal resistance

The overuse of combination antifungal-steroid creams can contribute to the development of antifungal-resistant strains of fungi, complicating future treatment efforts.

Pediatric concerns

Children are more susceptible to the side effects of potent topical steroids, including growth retardation and skin thinning. Therefore, this combination cream is generally not recommended for individuals under 17 years of age.

Lotrisone alternatives

Dr. Trowbridge recommends the following alternatives to Lotrisone (clotrimazole and betamethasone dipropionate), depending on the type of fungal infection:

Terbinafine or butenafine

These antifungals work better for dermatophyte infections like ringworm, athlete’s foot, and jock itch. They kill the fungus directly (fungicidal), penetrate the skin well, and stay active in the tissue. In comparison, clotrimazole only stops fungus from growing (fungistatic), making it less effective for these infections.

Ketoconazole or miconazole

These are good options for tinea versicolor, a common yeast-related skin condition. Topical terbinafine may also help. In mild cases, over-the-counter clotrimazole (without the added steroid) can be a reasonable first step.

Ketoconazole, econazole, miconazole, or ciclopirox

These may be more effective for stubborn yeast infections, especially if clotrimazole and betamethasone have been used repeatedly and resistance has developed.

Terbinafine or efinaconazole

For toenail fungus (onychomycosis), oral terbinafine or topical efinaconazole are better choices. Clotrimazole creams don’t penetrate the nail well and aren’t very effective for nail infections.

The right treatment depends on the type of fungus, where the infection is, and how your body responds to treatment. A board-certified dermatologist can help guide you to the most effective option.

Frequently asked questions about Lotrisone (clotrimazole and betamethasone dipropionate cream)

Can you buy clotrimazole and betamethasone dipropionate cream over the counter?

No, clotrimazole and betamethasone dipropionate cream is not available over the counter.  You need a doctor’s prescription to buy it. 

Is clotrimazole and betamethasone dipropionate cream more effective than other antifungal creams?

Dr. Trowbridge says that clotrimazole and betamethasone dipropionate creams are usually less effective than other antifungal medications because the antifungal component, clotrimazole, is one of the least versatile. It tends to be prescribed when the healthcare provider is unsure   if they are treating a fungal infection or an inflammatory skin condition.  Inaccurate diagnosis will lend itself to more likely treatment failures.  

How long does it take for clotrimazole and betamethasone to work?

Dr. Trowbridge says it is most likely to work for inflammatory skin conditions like eczema and psoriasis that require medium to high potency topical steroids.  If it responds quickly, it usually means the condition was unlikely to be a fungal infection.  In this case, clotrimazole was an unnecessary medication that may only have served to breed fungal resistance  When used to treat fungal infections of the feet, nails, and skin of the trunk and extremities, expect very slow improvement, if any. In order to reduce the chance of misdiagnosis and inaccurate treatment, seek dermatological care via Miiskin or any other dermatology clinic.

Is clotrimazole a strong steroid?

Dr. Trowbridge says that clotrimazole is not a steroid. It is an antifungal medication used to treat fungal infections by stopping the growth of fungus. However, it is often combined with betamethasone dipropionate, a potent corticosteroid. 

What is the best antifungal cream for a private area?

Dr. Trowbridge says the best antifungal cream for a private area depends on the type of fungal infection. For dermatophyte infections (like jock itch): Allylamine/benzylamine antifungals such as terbinafine or butenafine are the most effective options. For yeast infections (like candida intertrigo): Azole antifungals such as ketoconazole, miconazole, or econazole are good choices. These are effective against yeast, though resistance may sometimes be an issue with clotrimazole. Selecting the right cream depends on whether the infection is caused by a dermatophyte or yeast, so proper diagnosis is key.

How long does it take for a fungal infection to go away with clotrimazole?

Dr. Trowbridge says that some fungal infections caused by yeasts usually begin to improve within 1 to 2 weeks of using clotrimazole. However, treatment often needs to continue for 2 to 4 weeks to fully resolve the infection and prevent recurrence. If you don’t see any improvement, contact a dermatologist as you may have received an incorrect diagnosis or you need a stronger anti-fungal treatment. 

For how long can you use clotrimazole and betamethasone dipropionate cream?

Dr. Trowbridge says that you should avoid using this medication as it is not effective to treat most fungal infections, and the steroid is usually too strong.. If you have been prescribed this cream, ask your provider the intended use, and if uncertain, seek dermatological care via Miiskin or at an in-person dermatology clinic.

What are the drug interactions of clotrimazole and betamethasone dipropionate cream?

Dr. Trowbridge says that there are minimal systemic drug interactions since the cream is applied topically. However, using other corticosteroids or antifungals concurrently may increase the risk of side effects or overuse. Consult your doctor before combining treatments.

Can you use clotrimazole and betamethasone dipropionate cream while pregnant?

Under care of a trained provider, it may be appropriate in some cases to use this while pregnant.  Discuss risks with your healthcare provider.

Can children use clotrimazole and betamethasone dipropionate cream?

Children under 17 years old should not use this cream as they are more susceptible to side effects like skin thinning and hormone suppression from betamethasone.

Can you use clotrimazole and betamethasone dipropionate cream for eczema?

Dr. Trowbridge says that clotrimazole and betamethasone dipropionate cream should not be used for eczema. This cream is specifically designed to treat fungal infections with associated inflammation. Eczema, on the other hand, is not caused by a fungal infection and is better treated with moisturizers, barrier creams, and corticosteroids (without antifungal ingredients) as prescribed by your doctor. Using this combination cream may be effective as it contains an effective steroid, betamethasone, to treat eczema.  But the antifungal component is unnecessary.

Can clotrimazole and betamethasone dipropionate cream be used for hemorrhoids?

Dr. Trowbridge says that antifungals like clotrimazole are not useful for hemorrhoids.   Hemorrhoids are swollen veins in the rectal area and are not caused by fungal infections, which clotrimazole treats. High potency topical steroids like betamethasone can be helpful in some circumstances.

Can clotrimazole and betamethasone dipropionate cream be used for a vaginal yeast infection?

Dr. Trowbridge says that clotrimazole and betamethasone dipropionate cream should not be used for vaginal yeast infections. While clotrimazole is effective against the fungus causing most yeast infections, betamethasone may also suppress the local immune response, potentially worsening the infection or making it more difficult to treat. For vaginal yeast infections, use antifungal treatments specifically designed for vaginal use, such as clotrimazole or miconazole vaginal creams or suppositories, or in many cases oral antifungal medications. 

Can clotrimazole and betamethasone dipropionate cream be used for toenail fungus​?

Dr. Trowbridge says that clotrimazole and betamethasone dipropionate cream is not effective for toenail fungus (onychomycosis). While clotrimazole is an antifungal, topical treatments generally do not penetrate deeply enough into the nail to treat toenail fungus effectively, and clotrimazole has poor activity against dermatophyte fungi. Additionally, the corticosteroid betamethasone may increase the risk of side effects. For toenail fungus, oral antifungal medications like terbinafine, fluconazole, or itraconazole are often more effective. 

Article References:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818756
https://www.ncbi.nlm.nih.gov/books/NBK560643/
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818756
https://www.mayoclinic.org/drugs-supplements/betamethasone-and-clotrimazole-topical-route/description/drg-20061704