• 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 < 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.

In depth

• When used correctly, topical corticosteroids rarely cause serious adverse effects.
• The likelihood of adverse effects is directly related to the potency and amount of topical corticosteroids used — a thin layer should be applied once or twice a day, adjusting the potency to control symptoms.
• Systemic adverse effects are rare but include adrenal suppression that can result in symptoms of Cushing's syndrome and in children, growth retardation.
• Local adverse effects are more common:
• Transient burning or stinging is most common and may necessitate changing the product.
• Of more concern is skin atrophy, which is particularly common in the skin of the antecubital or popliteal fossae.
• Hypertrichosis, telangiectasia (especially on cheeks), acne, and steroid-induced contact dermatitis may also occur.

In depth

• Advise the person to apply the corticosteroid in a thin layer to all the affected areas.
• Most products will be supplied with an information leaflet which will specify the number of finger-tip units needed to treat specific body areas. One finger-tip unit is the amount of ointment or cream expressed from a tube with a standard 5 mm diameter nozzle, applied from the distal crease to the tip of the index finger, and is sufficient to treat a skin area about twice that of the flat of the hand with the fingers together.
• For acute episodes of contact dermatitis, advise the person to:
• Apply the topical corticosteroid no more than twice a day. For many people, once-daily application will be sufficient, but this can be increased if response is inadequate.
• Continue treatment for 48 hours after the dermatitis has cleared (if it has not improved after 2 weeks, the person should return for further advice).

In depth