Betamethasone Side Effects: Spectrum and Monitoring

Betamethasone is a potent fluorinated glucocorticoid. Side effects correlate with dose, duration, and route (systemic > topical).

Common (≥1–10%)

• Cutaneous: atrophy, striae, telangiectasia, acne, perioral dermatitis, hypopigmentation.
• Metabolic: fluid retention, hypertension, hyperglycemia, increased appetite/weight gain.
• Neuropsychiatric: insomnia, mood lability, euphoria, depression.

Less Common but Serious

• Cushingoid features (moon face, buffalo hump)
• Osteoporosis, avascular necrosis (femoral head)
• Glaucoma, posterior subcapsular cataracts
• Immunosuppression → infections (fungal, viral, TB reactivation)
• Adrenal suppression (HPA axis) → adrenal crisis on abrupt withdrawal
• GI: peptic ulcer, pancreatitis
• Growth suppression (children)

Monitoring & Mitigation

• Lowest effective dose, shortest duration.
• Topical: avoid occlusive dressings, face/groin, long-term high-potency.
• Systemic: calcium/vitamin D, bisphosphonate if >3 months; glucose/BP monitoring; taper gradually.
• Eye exams if prolonged periocular use.

Report new symptoms promptly. Benefits must outweigh risks for each indication.