Skin Disorder

Treating Scaly and Thickened Skin

When skin cells build up faster than they can shed, or an area is repeatedly rubbed and pressed, the outer layer thickens into rough scale, hard calluses or bumpy patches. Doctors call this hyperkeratosis, and the right approach depends on the cause. This page covers two very different medicines: salicylic acid creams, which work on the surface to clear scale, and betamethasone tablets, an oral steroid kept for short, doctor-directed courses when inflammation is severe.

Conditions That Cause Scaling

• Psoriasis: thick, silvery plaques on the elbows, knees and scalp. See our psoriasis treatments.
• Calluses and corns: hard skin caused by pressure or friction, usually on the feet and hands.
• Keratosis pilaris: small rough bumps on the upper arms and thighs, caused by plugs of keratin in hair follicles.
• Ichthyosis: an inherited or acquired tendency to dry, fish-scale-like skin, often on the shins.
• Hyperkeratotic hand and foot eczema: thick, cracked skin on the palms and soles.

How Salicylic Acid Works

Salicylic acid is a keratolytic. It loosens the bonds that hold dead surface cells together, so scale softens and sheds more easily. Clearing scale also helps steroid or vitamin D creams reach the inflamed skin beneath. It treats the build-up rather than the underlying cause, so it usually forms one part of a wider plan.

Products in This Range

Using Salicylic Acid Cream

• Apply a thin layer to the affected area only, usually once or twice a day or as directed. Soaking thick skin in warm water beforehand helps it work.
• Wash your hands afterwards unless you are treating them.
• Keep it away from the eyes, mouth, nostrils and genitals.
• Do not apply to broken, cracked, raw, infected or inflamed skin.
• Stinging, dryness and peeling are common. Stop and ask for advice if irritation is severe.

Why the treated area matters

Salicylic acid is absorbed through the skin. Spreading it over large areas, covering it with airtight dressings, using it on damaged skin or using it for long periods can raise blood levels enough to cause salicylate poisoning. Warning signs include ringing in the ears, nausea, vomiting, dizziness, confusion and fast, deep breathing; stop the cream and get medical help if they appear. Extra care is needed for:

• Children: use only on small areas and only on medical advice; not suitable for infants
• People with kidney or liver disease, or an allergy to aspirin
• Pregnancy and breastfeeding, when large areas should be avoided
• Anyone with diabetes or poor circulation, who should not treat corns or calluses on their feet without professional advice

Betamethasone Tablets for Severe Flares

Betnesol tablets contain betamethasone, a potent corticosteroid that suppresses inflammation throughout the body. A doctor may prescribe a short course for a severe inflammatory flare, such as widespread allergic contact dermatitis, a bad eczema flare or severe hives, and for serious allergic and breathing problems. They are not a routine treatment for scaly skin. Oral steroids are generally avoided in psoriasis, because stopping them can trigger a severe rebound flare.

• Never self-treat. The dose and length of the course are set by your doctor.
• Take the dose in the morning with food unless told otherwise, to reduce stomach upset and sleep disturbance.
• Do not stop suddenly after more than about three weeks of treatment or after repeated courses. The body's own steroid production is suppressed and the dose must be reduced gradually, as your doctor directs.

Even short courses can cause increased appetite, indigestion, poor sleep, mood changes and raised blood sugar or blood pressure. Longer use risks weight gain, thinning bones, cataracts, glaucoma, thin skin and infections. Tell your doctor if you have diabetes, a stomach ulcer, glaucoma, depression or an infection, and seek advice if you are exposed to chickenpox or shingles and are not immune. Taking anti-inflammatory painkillers such as ibuprofen alongside increases the risk of stomach bleeding.

Get urgent medical help for black or tarry stools, vomiting blood, severe mood changes or confusion, sudden blurred vision, or a fever or other signs of a serious infection.

Frequently Asked Questions

Can I use these creams on my face?

Salicylic acid at 6% or 12% is generally too strong for facial skin. Much lower strengths are used in acne washes and gels; see our acne range or ask a pharmacist.

How soon will my skin improve?

Rough, scaly skin often starts to soften within one to two weeks of regular use. Conditions such as ichthyosis and keratosis pilaris return when treatment stops, so a regular moisturizer is usually advised for maintenance.

Is betamethasone in tablets the same as in steroid creams?

It is the same steroid, but tablets act on the whole body and carry more risks. Never use leftover tablets for a new rash without medical advice.

Nothing on this page is a replacement for seeing a doctor or pharmacist about your own skin. Betamethasone tablets are a prescription medicine, and salicylic acid creams should be used only as directed on the pack or by your prescriber.