These recommendations are based on published expert opinion [Coulson, 1996; MeReC, 1999] and the British National Formulary [BNF 59, 2010].

• The recommendation to explain about the potency of the prescribed topical corticosteroid and provide a skin treatment plan is based on published opinion, and what CKS considers to be good practice.
• A questionnaire-based study was conducted to determine the level of use, and knowledge, of commonly-prescribed topical corticosteroids among parents or carers of 100 children attending paediatric outpatient clinics [Beattie and Lewis-Jones, 2003].
• 44% of parents/carers graded hydrocortisone 1% as potent.
• 42% did not grade betamethasone valerate 0.1% as potent.
• 29% graded clobetasol butyrate 0.05% as potent, and 12% graded it as weak.
• Poor adherence is a major cause of treatment failure in atopic dermatitis. The reasons for this include fear of adverse effects, failure to renew prescriptions on time, and lack of time. Most important however, is lack of knowledge about the treatment [Beattie and Lewis-Jones, 2003].
• The recommendation to issue a steroid treatment card if the person is receiving long-term treatment (several weeks) with a potent or very potent topical corticosteroid, is based on what CKS considers to be good practice.
• A guideline published by the Medicines and Healthcare products Regulatory Agency (MHRA) advises that high-risk people should be provided with a steroid card, at the discretion of the prescriber or pharmacist [CHM, 2006].
• Most topical corticosteroids may, under certain circumstances, be absorbed in sufficient amounts to cause systemic adverse effects [Sweetman, 2009].