Should I stop using betamethasone?

July 13, 2023 9:43 AM

I have been using topical betamethasone lotion for a patch of psoriasis on my scalp for over ten years…yikes! It has never really gotten worse or better, though I can’t really see it because it’s under my hair. The lotion controls the itching but unless I use it every day, it will start itching like crazy again. I’ve read about steroid rebound and I’m concerned that I’ve really set myself up to fail here. Should I stop using the betaderm? Should I try something else?

Yes, I have seen a dermatologist but they only re-prescribed the same lotion. I live in Canada so I can’t just go see another one.

posted by vanitas to Health & Fitness (5 answers total)

I’ve (I’m ashamed to admit) only seen a few stories with pictures of before and after on the daily mail of people who have gone through steroid cream “detox” but they said it got better after. I’m sure people will come on with better advice but I always use steroid cream sparingly but then use a bit of anti fungal after or in between. There is a kind of relationship between using a steroid and then fungal overgrowth. So as you consider this journey perhaps consider your fungal homeostasis as part of the issue that you want to consider too!!!!
posted by catspajammies at 9:50 AM on July 13, 2023

One side effect of cortisone is skin thinning/weakening, and that's why you're not supposed to use it chronically.

On the other hand, I'd guess if you were going to have that side effect you would have seen it by now. So it's a matter of balancing costs & benefits.

I have psoriasis (new to me) and had itchy spots on my scalp (that I cannot see, so can't say whether they're psoriatic or not). My primary care suggested using Selsun Blue shampoo for the menthol. It actually helped. Might be worth a try.
posted by Dashy at 9:51 AM on July 13, 2023

I had a rash that wouldn't go away for over a year, and I went to a dermatologist who took a biopsy which revealed nothing and then did a long-term exposure allergen test (very different than the normal allergist prick tests, you can't shower or exercise for a week!) and it turns out I've got [can't remember the exact language but akin to an delayed form of allergy] to half of all steroids, and so the steroid cream I was using to treat it was helping in the initial application and then causing it once my body registered it. (It also registered problems with formaldehyde, fragrance, and other chemicals such that I had to change my shampoo and conditioner, and that was also greatly helpful.) Also, now I use terbinafine cream as my rash application product as per my dermatologist, and it is better than nothing.

I'm not saying you have my sensitivities, but you could do the test and find your own.
posted by vegartanipla at 9:58 AM on July 13, 2023 [2 favorites]

I went to the dermatologist for the first time in a decade (in the US) and she told me that there are serval new topicals that have hit the market in the last few years/months. I walked away with a prescription for Vtama which seems to be a bit better for me than topical steroids were, it mostly cleared one of my spots and has improved two others compared to my baseline of using a topical steroid a few days per month. Maybe try asking again/differently about options?
posted by A Blue Moon at 11:38 AM on July 13, 2023

From personal experience, I used the same type of cream for a long time on my scalp and for a few spots around my eyes and ears and while it seemed fine on my scalp, I found it made the problem on my eyes worse. I've since switched to using Psoriasin on my non-scalp psoriasis patches and it works much better and the problem seems to have mostly subsided, whereas with the prescribed lotion it just kind of always seemed kind of not great.
posted by urbanlenny at 1:08 PM on July 13, 2023