What is clotrimazole and betamethasone dipropionate cream and why is it prescribed?
Dr. Ryan Trowbridge, board-certified dermatologist, talks about the excessive use of clotrimazole and betamethasone dipropionate in the treatment skin fungal infections and tells you why to avoid it.
Table of Content:
When is clotrimazole and betamethasone prescribed? | How to get a prescription for a skin fungal infection? | What fungal infections can you treat with it? | Can you buy it OTC? | What is the role of each ingredient? | When is better to use other antifungal creams? | Disadvantages | How long does it take to work? | Side effects | FAQ
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What is clotrimazole and betamethasone dipropionate cream?
Clotrimazole and betamethasone dipropionate is a topical prescription cream that may treat yeast infections (intertrigo) with itching and inflammation.
When is clotrimazole and betamethasone dipropionate prescribed?
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 some issues with this cream, says Dr Trowbridge. First, the steroid used in this preparation (betamethasone dipropionate) has a very strong potency for the locations for which it is most commonly utilized, generally the groin and genital areas, especially if the plan is to use it long term. Second, the antifungal used in this preparation (clotrimazole) is most effective for yeast infections, typically caused by candida yeast (which sometimes is a factor in the development of intertrigo) and not so effective for dermatophyte fungal infections (known as ringworm, athletes foot, tinea, etc.)
Dr. Trowbridge adds, “Whenever I see Lotrisone prescribed, it makes me think the provider is uncertain about the exact cause of the rash. Skin conditions can be tricky to diagnose, so it’s understandable why this medication is commonly used as a fallback option. If prescribed this medication, I encourage patients to ask more about what it is they are trying to treat, and why a combination of two frequently opposing therapies is being used. There may be a really good answer, but it deserves an explanation.”
How to get a prescription for a skin fungal infection?
You can have a photo-consultation appointment 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 dermatologists will make an assessment and will offer adequate treatment.
What fungal infections can you treat with clotrimazole and betamethasone dipropionate cream?
Dr. Trowbridge says that in very few cases, clotrimazole and betamethasone dipropionate cream can be used to treat yeast infections that are accompanied by a lot of inflammation (certain cases of candida intertrigo is one example), but its inappropriate use leads to frequent failures of therapy, and its high potency steroid is usually too strong on the locations for which it is often prescribed.
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.
What is the role of each ingredient in clotrimazole and betamethasone dipropionate cream?
Clotrimazole
Clotrimazole is an antifungal medication approved by the FDA for the treatment of fungal infections. It works by inhibiting the production of ergosterol, a key component of fungal cell membranes. Without ergosterol, the fungal cell membrane becomes unstable, leading to the death of the fungal cells. Clotrimazole is effective against yeasts from the Candida species, which may cause infections in certain moist skin areas and skin folds2.
Betamethasone dipropionate
Betamethasone dipropionate is a high-potency corticosteroid used to treat various inflammatory skin conditions, including eczema, dermatitis, rashes, and allergies. It addresses common symptoms such as redness, caused by increased blood flow to the affected area; swelling, due to fluid accumulation as part of the immune response; and itching and irritation. Betamethasone works by constricting blood vessels, inhibiting the release of inflammatory chemicals like prostaglandins and cytokines, and suppressing the immune system’s overactive inflammatory processes3. It is most appropriate for skin that is not infected with bacteria or fungus, and on areas of the body where the skin is thicker like the chest, back, abdomen, arms, legs, hands, and feet. It can be used for brief periods on the face, armpits, groin, and genitals, but always under the supervision and specific instruction of a provider experienced with diagnosing skin diseases and prescribing strong topical steroids.
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When is better to use other antifungal creams?
According to Dr. Ryan Trowbridge, it is better to use other antifungal creams in most cases as this cream tends to be ineffective for many fungal infections.
For example:
Dermatophyte infections (ringworm)
Allylamine/benzylamine antifungals like terbinafine or butenafine are more effective for treating ringworm because they are fungicidal, highly lipophilic, and create a reservoir effect in tissues. Clotrimazole, being a fungistatic azole, is less effective for these infections.
Tinea versicolor
This yeast overgrowth condition responds better to azoles like ketoconazole or miconazole and sometimes to topical terbinafine. Clotrimazole (without betamethasone dipropionate) may be effective in some cases and is a reasonable over the counter first option.
Refractory yeast infections
Due to potential resistance from overuse of clotrimazole and betamethasone cream, other antifungals like ketoconazole, econazole, miconazole, or ciclopirox might work better.
Toenail fungus (onychomycosis)
Topical treatments like efinaconazole or oral antifungals like terbinafine are more suitable. Clotrimazole-based creams do not penetrate nails effectively, and are not very effective at treating the type of fungus that causes nail fungal infections. In general, treatment choice depends on the specific fungal infection, its location, and resistance patterns, so it is best to consult a board-certified dermatologist to get the best treatment for your condition.
Disadvantages of clotrimazole and betamethasone dipropionate cream
Less effective for many fungal skin infections
- Clotrimazole betamethasone is not very effective at treating fungal infections caused by dermatophyte.
- More expensive than monotherapy
- This medication may be more expensive than buying a single ingredient generic formulation.
Tends to cause antimicrobial-resistant fungal infections
- Since this medication tends to be overly prescribed, even in cases where there isn’t a diagnosis of a fungal infection, this has led to antimicrobial-resistant dermatophytosis4.
Betamethasone too strong
- Betamethasone clotrimazole is frequently prescribed for candida intertrigo in intertriginous areas (places where skin touches skin like the armpits, groin, folds of the belly, etc.). In these locations, a weaker topical steroid is usually effective and safer.
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.
Side effects of clotrimazole and betamethasone dipropionate cream
Common side effects
- Skin irritation, burning, or stinging at the application site.
- Dryness or peeling of the skin.
- Temporary redness or itching.
Less common side effects
- Skin thinning (atrophy) as the steroid component can make this happen over time.
- Stretch marks, especially with use in areas like the groin or underarms.
- Skin may lighten or darken in the treated area.
- Overuse of the steroid can suppress the immune response, allowing the infection to spread or get worse (a condition called tinea incognito).
Rare reactions
- Allergic reactions with symptoms include rash, severe itching, swelling, or difficulty breathing. Stop using the cream and seek medical attention immediately if these occur.
- Systemic absorption of corticosteroids with long-term or extensive use, leading to side effects like weight gain, facial swelling, or fatigue5.
Precautions
- Avoid combining with other products that can irritate the skin (for example harsh cleansers, alcohol-based products) to reduce the risk of irritation.
- Notify your healthcare provider about any medications you are taking, especially if the cream is being applied to a large area or over a long period.
Potential drug interactions
Immunosuppressive medications (corticosteroids)
If you are taking other corticosteroids (oral or injectable), using betamethasone topically may increase the risk of systemic corticosteroid side effects, like adrenal suppression or delayed wound healing.
Topical medications
Using other topical products on the same area, especially those with similar active ingredients (antifungals or corticosteroids), could lead to overuse and increase the risk of side effects like skin thinning or irritation.
Drugs affecting liver enzymes
While rare with topical use, medications that induce or inhibit liver enzymes (such as rifampin or ketoconazole) could theoretically affect clotrimazole metabolism, particularly if used extensively or over large areas of the body6.
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Frequently asked questions about about clotrimazole and betamethasone dipropionate cream
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
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