13.4 Topical corticosteroids

Irritant preparations (tar, dithranol, vitamin D derivatives) should be avoided in flexural psoriasis. A mild steroid is appropriate.

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:

  • potent or very potent topical corticosteroids on the face or neck
  • potent topical corticosteroids in children under 12 months without specialist dermatological supervision
  • very potent topical steroids in children without specialist dermatological advice

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.

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.

Suitable quantities of corticosteroid preparations

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.

Mild

Hydrocortisone
  • Ointment 1% (£2.12 = 30g)
  • Cream 1% (£1.82 = 30g)

Indications

Dose

  • Apply thinly once or twice daily

Notes

  1. Hydrocortisone ointment and cream (1%) is available over the counter, at lower cost than a prescription, for the treatment of allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema. It cannot be sold for application to eyes/face, anogenital region, on broken or infected skin or for use in pregnancy or children under 10 years.

Mild with antimicrobials/ antifungals

Fucidin H®
  • Cream (fusidic acid 2%, hydrocortisone 1%) (£5.02 = 30g)

Indications

Daktacort®
  • Cream (hydrocortisone 1%, miconazole nitrate 2%) (£2.49 = 30g)

Indications

Moderate

Eumovate®
  • Ointment clobetasone butyrate 0.05% (£1.86 = 30g)
  • Cream clobetasone butyrate 0.05% (£1.86 = 30g)

Indications

Dose

  • Apply thinly once or twice daily

Notes

  1. Clobetasone butyrate (Eumovate®) cream can be sold over the counter, at lower cost than a prescription, for short-term symptomatic treatment and control of patches of eczema and dermatitis (but not seborrhoeic dermatitis) in adults and children over 12 years.
Betnovate-RD®
  • Ointment betamethasone valerate 0.025% (£3.15 = 100g)
  • Cream betamethasone valerate 0.025% (£3.15 = 100g)

Indications

Dose

  • Apply thinly once or twice daily
Fludroxycortide
  • Tape, 4 micrograms/cm2 (£8.19 = 7.5cm x 20cm)

Indications

  • Chronic localised recalcitrant dermatoses (but not acute or weeping)

Dose

  • Cut tape to fit lesion and apply to clean, dry skin shorn of hair, usually for 12 hours daily

Notes

  1. May be useful for hand eczema and localised skin cracks

Moderate with antimicrobials/ antifungals

Trimovate®
  • Cream (clobetasone butyrate 0.05%, oxytetracycline 3%, nystatin 100 000 units/g) (£3.29 - 30g)

Indications

Potent

Betamethasone valerate 0.1%
  • Ointment 0.1% (£2.39 = 30g)
  • Cream 0.1% (£3.24 = 30g)
  • Scalp application (aqueous) 0.1% (£3.19 = 100mL)

Indications

Dose

  • Apply thinly once or twice daily
Mometasone furoate
  • Ointment 0.1% (£1.89 = 30g)
  • Cream 0.1% (£2.11 = 30g)

Indications

Dose

  • Apply thinly once daily

Potent with antimicrobials/ antifungals

Fucibet® cream

(fusidic acid 2% / betamethasone valerate 0.1%)

  • Cream (£6.38 = 30g)

Indications

Potent with salicylic acid

Diprosalic®

(betamethasone 0.05%, salicylic acid 3%)

  • Scalp application (£10.10 = 100mL)

Indications

Very potent

Dermovate®
  • Ointment clobetasol propionate 0.05% (£2.69 = 30g)
  • Cream clobetasol propionate 0.05% (£2.69 = 30g)

Indications

Dose

  • Apply thinly 1–2 times daily for up to 4 weeks; maximum of 50g of 0.05% preparation per week

Notes

  1. Due to the risk of potential errors, clobetasol preparations should be prescribed by brand

Suitable quantities of corticosteroid preparations

The following quantities should be sufficient for two weeks treatment of once daily application:

Area of bodyAmount required for 2 weeks
Face and neck15-30g
Both hands15-30g
Scalp15-30g
Both arms30-60g
Both legs100g
Trunk100g
Groin and genitalia15-30g

 

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