Synopsis
Prescribe and explain emollients and topical corticosteroids by formulation, potency, site and fingertip units, while preventing fire, infection and cumulative steroid harm.
- Choose an emollient the patient will use: lotion spreads easily on hairy or weeping sites, cream is acceptable by day, and ointment reduces water loss most but is greasy and occlusive.
- Use emollient frequently and liberally, including as a soap substitute; pumps or clean spoons reduce contamination compared with repeated fingers in a tub.
- All emollients can contaminate clothing, bedding and dressings and increase fire severity; keep away from flames, cigarettes and ignition sources even after fabric feels dry.
- Match corticosteroid potency to diagnosis, age, site and thickness: mild for many thin sites, stronger for thick palms or soles, and very potent only for selected short supervised use.
- One adult fingertip unit is the cream or ointment from fingertip to distal crease of an adult index finger and covers about two adult handprints of skin.
- Apply topical corticosteroid to active inflammation, not as moisturiser; a once-daily preparation should not be doubled without a product-specific reason.
- For Emollients, topical corticosteroids and fingertip units, document body sites, severity, sleep and function, recent treatment, infection features and what the patient can realistically apply each day.
- In Emollients, topical corticosteroids and fingertip units, reassess the diagnosis when a well-used, correctly potent regimen fails rather than repeatedly intensifying treatment without examining adherence, exposure and mimics.
Key red flags
Sudden painful deterioration, monomorphic erosions, extensive pus or cellulitis, visual symptoms, suspected systemic steroid toxicity or severe emollient-associated burn requires prompt assessment.
Investigation priorities
Establish every leave-on, wash and corticosteroid formulation used on each anatomical area.
Management branches
Dry or eczematous skin needs a tolerated leave-on product and soap substitute.
- Offer a texture suited to dryness, hair, season and preference, avoiding aqueous cream as a leave-on choice when its surfactant irritates.
- Demonstrate smoothing with hair direction, frequent reapplication and hygienic pump or spoon dispensing, especially when infection recurs.
- Give fire-safety advice for every emollient and review stinging, folliculitis, contact allergy and whether prescribed quantity matches body area.
Key medicines
Hydrocortisone 1% creamAdults apply a thin layer once or twice daily to selected affected skin for no longer than seven days under this product licence.Avoid eyes, untreated infection and prolonged unsupervised face or flexure use; formulation excipients can irritate or sensitise and persistent symptoms need review.
Betamethasone valerate 0.1% creamApply thinly once or twice daily to selected affected skin for up to four weeks, then reduce frequency or potency as control is achieved.Avoid face, folds, genitals, untreated infection, large areas and occlusion unless directed; monitor atrophy, adrenal suppression risk and rebound.