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Dermatitis - contact - Management
Which topical corticosteroid should I prescribe?
- The potency of the topical corticosteroid prescribed depends on the severity of the dermatitis, the size of the area affected, the location of the dermatitis, and whether it is acute or chronic:
- For acute, severe, localized contact dermatitis on the body or limbs, prescribe a potent topical corticosteroid (e.g. betamethasone valerate 0.1%).
- For chronic or more widespread dermatitis (but less than 20% body surface area), potency may need to be reduced.
- In children, start treatment with a mildly potent topical corticosteroid (e.g. hydrocortisone 1%).
- For areas of thin skin (e.g. the face or genitals) and in flexures, prescribe a mildly potent topical corticosteroid.
- For areas of thick skin (e.g. palms or soles) and lichenified dermatitis, a potent topical corticosteroid will usually be needed, as penetration of topical corticosteroids is reduced, decreasing the effectiveness.
- The eyelids should be treated only with a mildly potent topical corticosteroid for a maximum of 5 days, taking care to avoid contact of the corticosteroid with the surface of the eye.
- Prescribe a topical corticosteroid in an appropriate formulation for the person and their condition:
- Ointments are recommended in preference to creams because they provide the strongest emollient effect.
- Creams may be preferred by some people, especially when used on visible areas, such as the face and hands:
- Creams are water-based and contain preservatives that can have irritant or allergen potential.
- Other formulations may be more suitable for specific areas of skin, such as the scalp, where liquids and foams will penetrate the hair better.
[Beck and Wilkinson, 2004; Beltrani et al, 2006]
Clarification / Additional information
- Table 1 shows the topical corticosteroid products available in the UK.
Table 1. Topical corticosteroids available in the UK.
Potency class | Non-proprietary names and strengths | Proprietary names | Formulations |
|---|
Mild* | Hydrocortisone 0.1%, 0.5%, 1.0%, 2.5% | Generic hydrocortisone, Dioderm®, Efcortelan®, Mildison® | Creams and ointments |
Moderate | Alclometasone dipropionate 0.05% | Modrasone® | Cream and ointment |
Betamethasone valerate 0.025% | Betnovate-RD® | Cream and ointment |
Clobetasone butyrate 0.05% | Eumovate® | Cream and ointment |
Fluocinolone acetonide 0.001% | Synalar 1 in 4 dilution® | Cream and ointment |
Fluocortolone 0.25% | Ultralanum Plain® | Cream and ointment |
Fludroxycortide 0.0125% | Haelan® | Cream, ointment, and tape |
Potent | Betamethasone dipropionate 0.05% | Diprosone® | Cream, ointment, and lotion |
Betamethasone valerate 0.1% | Generic betamethasone valerate, Betnovate® | Cream, ointment, lotion, scalp application, and foam |
Diflucortolone valerate 0.1% | Nerisone® | Cream, ointment, and oily cream |
Fluocinolone acetonide 0.025% | Synalar® | Cream, ointment, and gel |
Fluocinonide 0.05% | Metosyn® | Cream and ointment |
Fluticasone propionate 0.05% | Cutivate® | Cream and ointment |
Hydrocortisone butyrate 0.1% | Locoid® | Cream, ointment, lipocream, scalp application, and lotion |
Mometasone furoate 0.1% | Elocon® | Cream, ointment, and scalp application |
Very potent† | Clobetasol propionate 0.1% | Dermovate®, Clarelux® | Cream, ointment, and scalp application |
Diflucortolone valerate 0.3% | Nerisone Forte® | Ointment and oily cream |
* Hydrocortisone is available over-the-counter for the treatment of mild-to-moderate eczema not involving the face or genitals. † Very potent topical corticosteroids should usually only be prescribed by specialists. |
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- Table 2 shows the amount of corticosteroid required to treat a flare of dermatitis for 1 week in an adult (about half of this is needed for a child). Usually, 100 grams is adequate.
Table 2. Quantities of topical corticosteroid per week suitable for the treatment of a flare of dermatitis in an adult.
Part of body | Quantity of cream or ointment (grams) |
|---|
Face and neck | 15–30 |
Both hands | 15–30 |
Scalp | 15–30 |
Both arms | 30–60 |
Both legs | 100 |
Trunk | 100 |
Groin and genitalia | 15–30 |
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