Diprosalic: composition and presentation
Diprosalic comes in two forms — an ointment and a cutaneous solution — and their composition is almost, though not quite, the same. One gram of ointment contains 0.64 mg of betamethasone dipropionate, equivalent to 0.5 mg of betamethasone, and 30 mg of salicylic acid. One gram of the solution contains the same amount of betamethasone, but 20 mg of salicylic acid.
The one-third difference in salicylic acid is not accidental and follows from what each form is for: the ointment is meant for the skin of the body, the solution above all for the scalp, where a thick greasy layer is not wanted and the horny build-up needs less softening. That is why the two forms differ in their lists of indications as well as in the amount applied.
How Diprosalic works
There are two active substances and they work as a pair rather than in parallel. Betamethasone dipropionate is a synthetic fluorinated corticosteroid belonging to the potent class, group III. Applied topically it gives an anti-inflammatory and antipruritic effect and also constricts blood vessels — hence the rapid blanching and the settling of swelling in the lesion.
Salicylic acid applied topically softens keratin and the cornified epidermis and exfoliates it, easing the penetration of betamethasone dipropionate into the skin. Put differently, one component opens the way for the other: in psoriasis and chronic eczema the horny layer is thickened, and without a keratolytic the steroid simply would not reach the site of inflammation. That same arrangement has a reverse side, spoken of in the warnings: an open road works both ways, and both substances are absorbed through the skin into the blood. The thinner the skin, the larger the area and the longer the course, the more noticeable that reverse side becomes — hence nearly every restriction on this page.
Indications
The ointment is indicated for the topical treatment of subacute and chronic skin diseases: psoriasis, more severe forms of atopic dermatitis, circumscribed neurodermatitis, lichen planus and more severe forms of eczema, including nummular and contact eczema. What binds the list together is that in all of these the skin is not merely inflamed but thickened and covered with scales or crusts — which is exactly why a keratolytic was added to the steroid.
The solution has partly different indications, tied to the scalp: psoriasis of the scalp, more severe forms of seborrhoeic dermatitis, lichen planus, severe forms of allergic dermatitis, contact eczema within the scalp and lupus erythematosus. Common to both lists are the words "subacute and chronic" and "more severe forms": the medicine is a potent one and is prescribed not at the first patch of redness but when milder preparations have failed. Acute conditions do not appear at all, and that too makes sense: a weeping lesion has no need of softening and exfoliation.
Method of use and dosage
Both forms are used in adults and children over 12 twice a day, morning and evening; the description provides for no other schedule. In some cases a good result is achieved with less frequent application, so raising the frequency "to be sure" serves no purpose. The key limit is common to ointment and solution alike: treatment should not last longer than 14 days. If the disease returns, the course may be repeated.
| Form | How much to apply | How |
| Ointment | 0.2–0.5 cm of ointment per 10 cm² of skin surface | apply to the affected areas and rub in lightly, twice a day, for no longer than 14 days |
| Cutaneous solution | about 0.5 ml per 10 cm² of skin surface | apply to the altered areas of skin, twice a day, for no longer than 14 days |
Note how the amount is measured: it is given not as "a pea-sized blob" or "a thin layer" but tied to an area. A strip of ointment 0.2 to 0.5 cm long covers a patch of 10 by 10 centimetres — noticeably less than most people apply. That precision is not pedantry here: both the amount of the preparation and the area treated directly determine how much betamethasone and salicylic acid reach the blood.
Contraindications
The first group of bans is infection. The medicine is not used in bacterial skin infections, among which tuberculosis and syphilis are named, nor in viral ones — herpes, shingles, chickenpox — nor in fungal ones. The reason lies in the corticosteroid: by suppressing inflammation it suppresses the local immune response too, and under that cover an infection spreads freely and without its usual outward signs.
The second group covers the areas and conditions where a potent steroid is particularly harmful: acne vulgaris, rosacea, perioral dermatitis, the skin of the face, nappy rash, itching of the anal and genital area. The skin of the face and of the folds is thinner, absorption there is higher, and steroid complications — atrophy, dilated vessels, steroid dermatitis — develop faster. Children under 12 are not prescribed it at all. The list closes with hypersensitivity to betamethasone dipropionate, to salicylic acid or to any excipient.
Special warnings and precautions
The chief warning follows from the mechanism: corticosteroids and salicylic acid are absorbed through the skin, so with the ointment there is a risk of systemic adverse effects of the corticosteroid — including suppression of adrenal cortex function — and of salicylic acid. Hence four restrictions at once: avoid applying it to a large area of skin, to wounds and damaged skin, avoid large doses and prolonged treatment. Where such use is nonetheless necessary, special precautions are observed. For the same reason the medicine is not used under an occlusive dressing: that increases percutaneous absorption of the corticosteroid. Contact with the eyes and mucous membranes is avoided. If signs of irritation, allergy or excessive drying of the skin appear, use is stopped at once, and if a bacterial infection develops, appropriate antibacterial treatment is given.
Psoriasis is dealt with separately, even though it stands first among the indications. Topical corticosteroids in psoriasis can be dangerous for several reasons at once: relapse through the development of tolerance is possible, there is a risk of generalised pustular psoriasis, and there is general toxicity because the skin barrier is broken. The second special case is children. Their ratio of body surface to mass is greater than in adults, so suppression of the hypothalamic-pituitary-adrenal axis and the adverse effects typical of corticosteroids, including disturbances of growth and development, arise more readily. In children treated with topical corticosteroids, suppression of that axis, Cushing's syndrome, growth retardation, reduced weight gain and intracranial hypertension have been described; adrenal suppression showed itself as a fall in plasma cortisol and a lack of response to ACTH stimulation, and intracranial hypertension as a bulging fontanelle, headache and bilateral swelling of the optic discs. The medicine has no effect on the ability to drive.
Interactions with other medicines
The interactions section of the description consists of a single sentence: no interaction studies have been carried out. That is an honest formulation rather than an assurance that any combination is safe, and it should be read exactly so — there are no data.
The practical conclusion is carried over from the neighbouring sections. Since both active substances are absorbed through the skin, everything that increases that absorption matters: the area treated, damaged skin, an occlusive dressing, the simultaneous use of other topical products on the same areas. Other preparations with salicylic acid and keratolytics deserve separate attention — combining them with Diprosalic adds up the load on the skin. It is worth telling the doctor about any topical products you already use, even ones bought without a prescription.
Pregnancy and breastfeeding
There are no data on the use of corticosteroids in pregnant women. The wording of the description is the standard one for such a case: the medicine may be used only where the potential benefit to the mother outweighs the possible risk to the foetus. At the same time, animal studies have shown that topically applied corticosteroids can act teratogenically, and that caveat is not one to overlook.
With breastfeeding the wording is more cautious still: it is not known whether topical corticosteroids are absorbed through the skin to an extent that lets them pass into breast milk. The decision is made by choosing between stopping breastfeeding and stopping the medicine, weighing the benefit of feeding for the child against the benefit of treatment for the mother. In practice that means the choice will differ between extensive lesions with long treatment and a small area with a short course.
Adverse reactions
The local reactions observed with corticosteroids form a predictable series: burning, itching, irritation, drying of the skin, folliculitis, excessive hair growth, acneiform eruptions, loss of skin pigment, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infections, skin atrophy, striae and prickly heat. It is noted separately that prolonged topical use of preparations containing salicylic acid may cause dermatitis — that is, the substance meant to prepare the skin for treatment becomes, in excess, the cause of inflammation itself. Some of these reactions are not recognised at once: thinning of the skin and striae develop gradually, while acneiform eruptions and perioral dermatitis are easily mistaken for a flare of the underlying disease, so that the very treatment causing them is continued.
The second part of the section concerns systemic effects. As a result of the active substances being absorbed into the blood, the general adverse effects of betamethasone typical of corticosteroids, and those of salicylic acid, are possible. The qualification about when this happens matters: general adverse effects occur above all with prolonged use, with application to a large area of skin and with use in children. All three conditions are exactly the restrictions listed in the warnings, and the coincidence is not accidental.
Overdose
For a topical product an overdose looks unusual: it is not a single excess but an accumulated result. Prolonged topical use of corticosteroids may lead to suppression of the hypothalamic-pituitary-adrenal axis and consequently to secondary adrenal insufficiency, as well as to overactivity of the adrenal cortex up to Cushing's syndrome. Topical use of salicylic acid over a long period or in large doses may cause salicylic acid poisoning.
Treatment is symptomatic and differs for the two substances. The acute features of an excess of adrenal cortex hormones are usually reversible; electrolytes are corrected if necessary, and in chronic poisoning corticosteroids are withdrawn slowly and gradually — abrupt withdrawal here is more dangerous than the excess itself. Salicylic acid poisoning is treated symptomatically, with measures to remove the salicylates from the body quickly: oral sodium bicarbonate is advised to alkalinise the urine, along with forced diuresis.
How to get a Diprosalic prescription online
A potent topical corticosteroid is not something to choose on your own: whether the medicine helps or makes things worse depends on what exactly is on the skin, since in a fungal or viral infection it is directly contraindicated. At e-zdrowie.com you fill in a medical questionnaire, the doctor reviews the answers and, if the medicine is suitable, issues an electronic prescription: the code arrives by message, and any Polish pharmacy will dispense the ointment or the solution against it.
In the questionnaire describe where the lesions are and what they look like, how long they have been there, whether there is itching, scaling, weeping or pustules. State whether a diagnosis has already been made — psoriasis, atopic dermatitis, eczema, seborrhoeic dermatitis — and by whom, what you were treated with before and with what result. Be sure to report whether the face, the skin folds and the genital area are involved, whether there are signs of infection, pregnancy or breastfeeding, and how old the patient is: children under 12 are not prescribed it. Mention separately if the lesions are extensive: the area affects both the doctor's decision and the length of the course, which is limited to two weeks in any case.
