Adult male: one fingertip unit = 0.5g

Adult female: one fingertip unit = 0.5g

Children \~4yo = 1/3 Adult

Infants \~6/12-1yr = 1/4 Adult

One hand: 1 fingertip unit

One arm: 3 FTU

One foot: 2 FTU

One leg: 6 FTU

Face and neck: 2.5 FTU

Trunk,front and back: 14 FTU

Whole body - \~40 FTU

Use weakest steroid to do the job

Low potency

  • treating large areas or for longer term applicatin

  • more suitable for use on children or areas of thinner skin, such as face, groin or axilla

More potent

  • severe conditions

  • areas that have thicker skin:

    • palms, soles

  • shouldn’t be used under occlusion or thinner skin

  • shouldn’t be used > 3/52 - tachyphylaxis

    • gradually tapered to prevent rebound

Ointments:

  • greasy and remain on skin after they are applied

  • particularly useful dry, thick, lichenified skin

  • ointment > cream (potent)

    • occlusive nature of ointment

Creams

  • preferred by patients

  • exposed areas

  • moist or weeping lesions

  • more preservatives and excipients cf. ointments

Lotions

  • thin consistency

  • easier to apply to hairy areas = scalp

  • contain etoh and have drying effect on exudative leisons

  • may sting on application

Class 1

Very potent - 600 times as potent as hydrocortisone

  • Clobetasol propionate (Dermol)

  • Betamethasone dipropionate (Diprosone OV)

Class 2

Potent - 100-150 times as potent as hydrocortisone

  • Betamethasone valerate (Beta, Betnovate)

  • Betamethasone dipropionate (Diprosone, Daivobet 50/500)

  • Diflucortolone valerate (Nerisone)

  • Hydrocortisone 17-butyrate (Locoid)

  • Mometasone (elocon)

  • methylprednisolone aceponate (advantan)

Class 3

Moderate - 2-25x cf. hydrocort

  • Clobetasone butyrate (Eumovate)

  • Triamcinolone acetonide (aristocort, viaderm, kenacomb)

Class 4

Mild

  • Hydrocortisone

Skin absorption

  • Lotions easy to apply

  • Creams rub in well

  • Ointments most effectve dry

  • Gels/solutions: hairy/dying

  • Potent / very potent avoided face

Side effects

  • if >50g/500g hydrocortisone / week:

    • enough absorbed for systemic side effects

    • Cushing

    • Adrenal gland suppression

Skin side effects:

  • Skin atrophy/stretch marks (striae)

  • Easy bruising

  • perioral dermatitis

  • Enlarged blood vessels

  • susceptible to skin infections

  • Allergy