Augmented betamethasone dipropionate ointment is a super-high-potency topical steroid used to treat inflammatory skin conditions, most commonly plaque psoriasis and severe eczema. It’s FDA-approved for relieving the inflammation and itching of corticosteroid-responsive dermatoses in patients 13 years of age and older. The word “augmented” refers to a specially designed base that increases how deeply the steroid penetrates the skin, making it more potent than standard betamethasone formulations.
Conditions It Treats
The primary use backed by clinical trials is chronic plaque psoriasis, the most common form of psoriasis that causes raised, scaly patches on the skin. Its FDA approval was established through two randomized controlled trials in people with this condition. Beyond psoriasis, it’s prescribed for a range of stubborn inflammatory skin problems that respond to corticosteroids, including severe eczema (atopic dermatitis), contact dermatitis, and other conditions where lower-potency steroids haven’t worked.
Because this is one of the strongest topical steroids available, it’s typically reserved for thick, resistant patches of inflammation rather than mild rashes. Your doctor may prescribe it when you’ve already tried a weaker steroid without enough improvement.
Why “Augmented” Matters
Betamethasone dipropionate exists in both standard and augmented formulations at the same 0.05% concentration. The difference is the vehicle, meaning the base ingredients the steroid is mixed into. The augmented version uses a combination of propylene glycol, wax, and petrolatum specifically designed to drive more of the active steroid through the outer layer of skin and into the inflamed tissue beneath. This enhanced penetration is what pushes the augmented ointment into Class I (super-high potency) on the seven-tier potency scale, while a different betamethasone dipropionate 0.05% ointment formula sits in Class II (high potency). Same drug, same concentration, meaningfully different strength.
How to Apply It
The standard recommendation is to apply a thin layer to the affected skin once or twice a day. A useful way to gauge the right amount is the fingertip unit: a strip of ointment squeezed from a standard tube along the length of your index fingertip (from the tip to the first crease) equals roughly 0.5 grams and covers about 2% of an adult’s body surface area. Your palm, for reference, represents about 1% of your body surface.
Total use should stay at or below 45 grams per week. At around 7 grams per day applied twice daily for two to three weeks, studies found only minimal suppression of the body’s natural cortisol production. But at 14 grams per day, cortisol levels dropped significantly, which is why the weekly cap exists. If your symptoms haven’t improved within two to four weeks, that’s a signal to follow up rather than continue applying it.
Where Not to Use It
This ointment should not be applied to the face, groin, or underarms. The skin in those areas is thinner, absorbs more steroid, and is far more vulnerable to damage from a product this potent. Skin thinning, visible blood vessels near the surface, and stretch marks are all more likely when super-high-potency steroids are used on delicate skin, under bandages or wraps (called occlusive use), or for extended periods.
If you already have noticeable skin thinning at the site you’re considering treating, this ointment is not appropriate for that area. Your prescriber can recommend a lower-potency alternative for sensitive locations.
Potential Side Effects
The most common side effects are local, meaning they happen at the spot where you apply the ointment. These include burning, stinging, or itching right after application, dryness, and skin irritation. With prolonged or excessive use, more concerning changes can develop: the skin can become noticeably thinner, small blood vessels can become visible beneath the surface, and stretch marks may form. These changes can be slow to reverse and sometimes permanent.
The bigger systemic risk with any super-potent topical steroid is that enough of it absorbs through the skin to affect your adrenal glands, which produce cortisol. When external steroids flood the system, the adrenals can dial back their own production. This is why the 45-gram weekly limit and the two-to-four-week treatment window matter. Children and anyone applying the ointment to large areas of skin are at higher risk for this kind of absorption, which is part of why it’s not approved for anyone under 13.
How It Works in the Skin
Like all topical corticosteroids, this ointment works by calming an overactive immune response in the skin. It reduces the redness, swelling, heat, and itching that come with inflammation. It also constricts small blood vessels in the treated area, which further reduces redness and swelling. The effect is not a cure for the underlying condition. It suppresses the inflammatory flare so the skin can heal and symptoms can be managed, but psoriasis and eczema can return once treatment stops.
The ointment base itself also plays a therapeutic role beyond boosting penetration. Petrolatum-based ointments form a moisture-trapping layer over the skin, which helps restore the damaged skin barrier that inflammatory conditions break down. For dry, thickened plaques of psoriasis, this occlusive quality makes the ointment form particularly effective compared to creams or lotions.