13.4 Topical corticosteroids

It is important to prescribe the appropriate potency of steroid according to the severity of the disease. Flare-ups can be treated with a potent or very potent steroid and then stepped down to an appropriate potency of steroid or even an emollient. By treating actively, you are more likely to get the skin condition under control.

The long-term use of potent and very potent steroids should only be recommended by a dermatologist, GPwSI or nurse specialist.

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

Choice of Preparation

Ointments are preferable to creams as they have a deeper, more prolonged emollient effect and increase the penetration of steroid. They are also less likely to cause irritation (as they do not contain preservatives) and/or sensitisation to the product.

Patients may prefer creams for application to the face and can be more suitable for moist or weeping lesions.

Dilution of topical corticosteroid preparations in emollient diluents to reduce steroid potency is not advised. The shelf life of the diluted product is significantly reduced leading to unsafe use past expiry date and waste of unused preparation. Diluted preparations are significantly more expensive (often greater than £100 per 100g). It is preferable to choose a ready-made product at the required steroid potency.

With antimicrobials/ antifungals

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.

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).

Mild

Hydrocortisone
  • Ointment 0.5%, 1%, 2.5% (£2.12 = 30g 1%)
  • Cream 0.1%, 0.5%, 1%, 2.5% (£1.82 = 30g 1%)

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

Canesten HC®
  • Cream (hydrocortisone 1%, clotrimazole 1%) (£2.42 = 30g)

Indications

Dose

  • Apply thinly once or twice daily
Daktacort®
  • Ointment (hydrocortisone 1%, miconazole nitrate 2%) (£2.50 = 30g)
  • Cream (hydrocortisone 1%, miconazole nitrate 2%) (£2.49 = 30g)

Indications

Dose

  • Apply thinly once or twice daily
Fucidin® H
  • Cream (hydrocortisone 1%, fucidic acid 2%) (£5.02 = 30g)

Indications

Dose

  • Apply thinly once or twice daily

Moderate

Eumovate®
  • Clobetasone butyrate ointments 0.05% (£1.86 = 30g)
  • Clobetasone butyrate cream 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®
  • Betamethasone valerate ointment 0.025% (£3.15 = 100g)
  • Betamethasone valerate cream 0.025% (£3.15 = 100g)

Indications

Dose

  • Apply thinly once or twice daily
Fludroxycortide
  • Ointment 0.0125% (£3.26 = 60g)
  • Cream 0.0125% (£3.26 = 60g)

Indications

  • Inflammatory skin disorders such as eczemas

Dose

  • Apply thinly 1–2 times 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, apply to clean, dry skin shorn of hair, usually for 12 hours daily

Notes

  1. May be useful to prevent picking of atopic eczema lesions and consequent damage to the skin

Moderate with antimicrobials/ antifungals

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

Indications

Dose

  • Apply thinly once or twice daily

Potent

Betamethasone valerate
  • Ointment 0.1% (£2.39 = 30g)
  • Cream 0.1% (£3.24 = 30g)
  • Scalp application 0.1% (£3.19 = 100ml)
  • Foam 0.12% (£9.75 = 100g)

Indications

Dose

  • Apply thinly once or twice daily
Synalar®
  • Fluocinolone acetonide gel 0.025% (£5.56 = 30g)

Indications

Dose

  • Apply thinly 1–2 times daily
Metosyn®
  • Fluocinonide ointment 0.05% (£3.50 = 25g)
  • Fluocinonide cream 0.05% (£3.96 = 25g)

Indications

Dose

  • Apply thinly 1-2 times daily
Mometasone furoate
  • Ointment 0.1% (£1.89 = 30g)
  • Cream 0.1% (£2.11 = 30g)

Indications

Dose

  • Apply thinly once daily
Hydrocortisone butyrate
  • Locoid® ointment 0.1% (£1.60 = 30g)
  • Locoid® cream 0.1% (£1.60 = 30g)
  • Locoid® lipocream 0.1% (£1.69 = 30g)
  • Locoid® scalp lotion 0.1% (£6.83 = 100mL)
  • Locoid Crelo® lotion (emulsion) 0.1% (£5.91 = 100g)

Indications

Dose

  • Apply thinly 1–2 times daily

Potent with antimicrobials/ antifungals

Betamethasone and clioquinol
  • Ointment (betamethasone 0.1%, clioquinol 3%) (£28.88 = 30g)
  • Cream (betamethasone 0.1%, clioquinol 3%) (£28.88 = 30g)

Indications

Dose

  • Apply thinly once or twice daily
Betamethasone and neomycin
  • Ointment (betamethasone 0.1%, neomycin sulphate 0.5%) (£17.74 = 30g)
  • Cream (betamethasone 0.1%, neomycin sulphate 0.5%) (£17.74 = 30g)

Indications

Dose

  • Apply thinly once or twice daily
Fucibet®
  • Cream (betamethasone 0.1%, fusidic acid 2%) (£6.38 = 30g)

Indications

Dose

  • Apply thinly once or twice daily

Potent with salicylic acid

Diprosalic®
  • Ointment (betamethasone 0.05%, salicylic acid 3%) (£9.14 = 100g)
  • Scalp application (betamethasone 0.05%, salicylic acid 3%) (£10.10 = 100ml)

Indications

Very Potent

Dermovate®
  • Ointment clobetasol propionate 0.05% (£2.69 = 30g)
  • Cream clobetasol propionate 0.05% (£2.69 = 30g)
  • Scalp application clobetasol propionate 0.05% (£10.42 = 100ml)

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
Etrivex®
  • Shampoo clobetasol propionate 0.05% (£10.29 = 125ml)

Indications

Dose

  • Apply thinly once daily, rinse off after 15 minutes; reduce frequency of application after clinical improvement; maximum duration of treatment 4 weeks
Diflucortolone valerate
  • Oily cream 0.3% (£4.70 = 15g)

Indications

Dose

  • Apply thinly 1–2 times daily for up to 2 weeks.

 

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