Topical corticosteroids

What are topical corticosteroids?

Topical corticosteroids are a form of medicine applied directly to the skin which helps reduce inflammation, redness and irritation. The type of steroid is similar to those produced naturally in the body. Topical corticosteroids come in many preparations: ointments, creams, lotions and tapes. Ointments (rather than creams) are generally best for dry skin conditions however is if the skin is wet and weepy a cream is usually preferred.

What are the different strengths of topical steroids?

Your doctor or specialist nurse will identify the correct strength of steroid for you to use on different parts of the body. They will also discuss how to increase or decrease treatment appropriately using the steroid ladder.

Topical steroid ladder (worsening itch 1-5, redness, scratch marks, thickness)

Betnovate (potent)
Betnovate RD/Eumovate (moderate)
Hydrocortisone 1% (mild)
Dermovate (very potent)

Topical corticosteroids are used on adults, children and young people. In adults, more potent steroids are typically used on the body and mild/moderate steroids on the face and skin folds (under arms, breast folds, groin and genitals).

Children and young people will be guided by their doctor or specialist nurse on the use of mild and moderate steroids and when required, potent steroids will be used to treat severe skin conditions.

Picture of someone washing their hands in a sink.

How should topical corticosteroids be applied?

Step 1

Always wash your hands for 20 seconds before applying a topical corticosteroid.

Picture of someone with a line of cream on their first finger.

Step 2

Squeeze the topical steroid in a line from the last finger crease to the fingertip. This is a fingertip unit (FTU). One FTU would be sufficient to treat an area equivalent to two adult handprints.

Picture of someone spreading the cream onto the top of their arm.

Step 3

Apply to the affected area in a downwards motion following the hair growth. Do not rub in as this can block the follicles and cause infection.

Step 4

Always wash your hands for 20 seconds after applying a topical corticosteroid.

How much topical corticosteroid should be applied?

A thin shiny layer should cover the affected area. The fingertip unit method (FTU) gives a general estimate of how much should be used. One FTU would be sufficient to treat an area equivalent to two adult handprints. In children the fingertip and two handprints are based on that of an adult also. The tables below show how much is estimated to be used. This is based on the whole area being treated therefore if only a proportion of the area is affected the number of FTU should be adjusted accordingly.

Adult and young people

Site	Number of FTU to treat given body area
Scalp	3
Face and neck	2.5
Front and back of one hand	1
One arm and hand	4
One leg and entire foot	8
Trunk front	8
Trunk back	8

Children

Number of finger tip units

Age	Entire face and neck	Entire arm and hand	Entire leg and foot	Entire front of chest and abdomen	Entire back including buttocks
3-12 months	1	1	1.5	1	1.5
1-2 years	1.5	1.5	2	2	3
3-5 years	1.5	2	3	3	3.5
6-10 years	2	2.5	4.5	3.5	5

How long should I use topical corticosteroids?

It is important that you follow the treatment plan given by your doctor or specialist nurse in order for your skin to avoid a flare of your skin condition. If used correctly, topical corticosteroids should not cause side effects. Thinning of the skin and stretch marks will occur only if a strong steroid is used incorrectly or over a prolonged period of time.

Can topical corticosteroids be used in pregnancy and breastfeeding?

Topical corticosteroids have been used by a large number of pregnant and breast feeding women without any evidence of harmful effects. However, there is limited information about the safety of topical corticosteroid use in pregnancy and during breast feeding. This should be discussed with your doctor or specialist nurse to make sure the benefits outweigh the risks. To avoid transfer to the infant only mild and moderate topical corticosteroids should be used on the breast and around the nipple, and these should be washed off before breastfeeding.

Precautions

Topical corticosteroids contain paraffin which is flammable. Do not smoke, use naked flames (e.g. candles, BBQs, be near people who are smoking or using naked flames) or be near anything else which may cause a fire whilst these products are in contact with your skin, clothes dressings or bandaged.

If a topical corticosteroid causes irritation, please seek advice from your medical or nursing team.

If you are also using an emollient as part of your treatment plan do not apply it at the same time as it may dilute your treatment and cause it not to work as effectively. An emollient should be applied 30 minutes prior to applying a steroid or vice versa.

If you are having ultraviolet light treatment or radiotherapy, check with your medical and nursing team if there is any specific guidance on your emollient use prior to starting treatment.

Topical corticosteroids do not contain SPF and should not be used as sun protection. They should not be applied prior to sun exposure. Sun creams should be used when skin is exposed to direct sunlight with a medium/high UV level.

Topical corticosteroids can worsen skin infections. If you have a bacterial, viral or fungal skin infection they should therefore be avoided, unless they are applied with an anti-infective agent or you are started on tablet medication to treat the infection. You should seek advice from your doctor and specialist nurse if you think you may have a skin infection.

Useful sources of information

British Association of Dermatologists (BAD)

DermNet NZ

For Further Information

Medicines Information Patient Helpline:

Tel: 0191 282 3016. Available 9am to 4pm, Monday to Friday (excluding Bank Holidays). This helpline is available for patients of the Newcastle upon Tyne Hospitals, to answer any questions they may have regarding their medicines.