Treat infection if present; discontinue if infection persists or worsens. Do not use near eyes, or on diaper dermatitis or pre-existing skin atrophy. Do not use fluorinated steroids longer than 1 week on the face. Avoid abrupt cessation in chronic use. Systemic absorption increased by broken or inflamed skin, prolonged use, application to large surface area, or use of occlusive dressings. Occlude only if necessary; do not occlude higher potency products. Monitor adrenal function in children if a high potency product or occlusion is used, and in adults if more than 50g weekly of a high potency product is used. Discontinue or reduce dose or potency if HPA axis suppression, Cushing's syndrome, hyperglycemia, glucosuria, or irritation occurs. Use lowest effective dose and potency (esp. in children). Use caution if applying to face or body folds. Do not use continuously or for prophylaxis. Foams are flammable. Reevaluate periodically. Pregnancy (). Nursing mothers.
(22RS)-16α,17α-Butylidenedioxy-6α,9α-difluoro-.,21-dihydroxypregn-4-ene-3,20-dione ( g) was resolved into its 22R- and 22S-epimers by chromatography on a Sephadex LH-20 column (76× cm) using a n-heptane-chloroform-ethanol (20:20:1) mixture as mobile phase. The fractions 1845-2565 ml (A) and 2745-3600 ml (B) were collected and evaporated. The two products were precipitated from methylene chloride - petroleum ether. The product from fraction A (332 mg) was identified with 1 H-NMR and mass spectrometry to be (22S)-16α,17α-butylidenedioxy-6α,9α-difluoro-.,21-dihydroxypregn-4-ene-3,20-dione and the product from the B fraction (918 mg) as the 22R-epimer.