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.
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.
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.
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.