Derzid-C Special Precautions

Carcinogenicity: Long-term animal studies to determine the carcinogenicity of topical corticosteroids have not been done.
Mutagenicity: Betamethasone was found to be genotoxic in the in vitro human peripheral blood lymphocyte chromosome aberration assay with metabolic activation and in the in vivo mouse bone marrow micronucleus assay.
Use in children: Children and adolescents have a large skin surface area to the body weight ratio and less developed, thinner skin, which may result in absorption of greater amounts of topical corticosteroids compared with older patients. Absorption also is greater in premature infants than in full term newborns, due to inadequate development of the stratum corneum. Adrenal suppression, Cushing's syndrome, intracranial hypertension and growth retardation due to the systemic absorption of topical corticosteroids have been documented in children. Therefore, special care must be exercised when these agents are used in children and growing adolescents, especially if factors that increase absorption are involved. It is recommended that only low-potency, unfluorinated topical corticosteroids that have a free 17-hydroxyl group be used in children or growing adolescents unless there is a demonstrated need for one of the other topical corticosteroids. Generally, pediatric therapy continuing for longer than 2 weeks and consisting of doses in excess of 1 daily application (with medium- or high-potency corticosteroids) or 2 daily applications (with low-potency corticosteroids) should be evaluated carefully by the physician. This is especially important if medication is applied to >5-10% of the body surface or if an occlusive dressing is used. A tight-fitting diaper or one covered with plastic pants may constitute an occlusive dressing.
Use in the elderly: Although appropriate studies with topical corticosteroids have not been performed in the geriatric population, geriatrics-specific problems are not expected to limit the usefulness of topical corticosteroids in the elderly. However, elderly patients may be more likely to have preexisting skin atrophy secondary to aging. Purpura and skin lacerations that may raise the skin and SC tissue from deep fascia may be more likely to occur with the use of topical corticosteroids in geriatric patients. Therefore, topical corticosteroids should be used infrequently, for brief periods or under close medical supervision in patients with evidence of preexisting skin atrophy. Use of lower potency topical corticosteroids also may be necessary in some patients.