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Potency of a topical corticosteroid preparation is a result of the formulation as well as the corticosteroid. The potency of steroid should be matched to the severity of the disease, using the least potent steroid that effectively controls the disease.
Do not use:
The preferred formulation for corticosteroids is usually ointment as they are more moisturising than cream, and contain less or no preservatives.
The advantages of including other substances (such as antibacterials or antifungals) with steroids in topical preparations are debatable, but they may have a place where there is associated bacterial or fungal infection.
NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is mild irritant dermatitis.
Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.
MHRA Drug Safety Update (September 2021): topical corticosteroids: information on the risk of topical steroid withdrawal reactions
Topical corticosteroid preparations should be applied no more frequently than twice daily; once daily is often sufficient.
Topical corticosteroids should be spread thinly on the skin but in sufficient quantity to cover the affected areas. The length of cream or ointment expelled from a tube may be used to specify the quantity to be applied to a given area of skin. This length can be measured in terms of a fingertip unit (the distance from the tip of the adult index finger to the first crease). One fingertip unit (approximately 500 mg from a tube with a standard 5 mm diameter nozzle) is sufficient to cover an area that is twice that of the flat adult handprint (palm and fingers).
See below for the quantities that should be sufficient for two weeks treatment of once daily application.
Indications
Dose
Notes
(Fusidic acid 2% / hydrocortisone 1%)
Indications
(Hydrocortisone 1% / miconazole nitrate 2%)
Indications
(Clobetasone butyrate 0.05%)
Indications
Dose
Notes
(Betamethasone valerate 0.025%)
Indications
Dose
Indications
Dose
Notes
(Combination of clobetasone butyrate 0.05% w/w, oxytetracycline 3.0% w/w, and nystatin 100,000 units per gram)
Indications
Dose
Indications
Dose
Notes
Indications
Dose
(Fusidic acid 2% / betamethasone valerate 0.1%)
Indications
(Betamethasone 0.05% / salicylic acid 3%)
Indications
Due to the risk of potential errors, clobetasol preparations should be prescribed by brand
If treatment with a local corticosteroid is clinically justified beyond 4 weeks, a less potent corticosteroid preparation should be considered.
(Clobetasol propionate 0.05%)
Indications
Dose
(Clobetasol propionate 0.05%)
Indications
Dose
The following quantities should be sufficient for two weeks treatment of once daily application:
Area of body | Amount required for 2 weeks |
---|---|
Face and neck | 15-30g |
Both hands | 15-30g |
Scalp | 15-30g |
Both arms | 30-60g |
Both legs | 100g |
Trunk | 100g |
Groin and genitalia | 15-30g |