Dermatology
Many of the creams and ointments used for skin conditions are based on cortisone and are in the family of medicines called “steroids”. They are used to take the inflammation (angriness) out of the skin. They work for many hours in the skin, so need only be put on once or possibly twice a day. They should be stopped when the skin is clear of rash.
Note that they are completely different from the other family of drugs, so called “anabolic steroids”, which are drugs sometimes taken by athletes.
The ladder
The ladder diagram shows the ointments in order of strength. On the bottom rung is Hydrocortisone, which is weak. It can be used for a long time without causing problems as a rule, even when put onto delicate skin of the face. On the top rung is Dermovate, which is so strong that it can easily cause side effects if too much is used for too long. For example, it may cause thinning of the skin. It is usually given only for the most severe skin conditions and under close medical supervision.
Going up the ladder
If you are using one of the weaker preparations, on the lower rungs of the ladder, and your skin seems to have become worse, the doctor may suggest that you “go up” a step or two and use a stronger ointment. Once the skin has improved, go back down a step.
Infection
If your usual ointment does not seem to be working this may be because there is an infection. This may make the skin weep or form crusts on the surface. If a stronger ointment is used without antibiotics, the infection may become worse, so it is important to check with the doctor before going up to a stronger ointment. Skin infection usually responds well to antibiotics, although they often need longer than the normal course.
Ointment or cream?
Ointments (like Vaseline) are greasy and should be used when the skin is dry and scaly. Creams are white and should be used when the skin is moist and weeping.
Long-term use
For regular use, it is best to stick to one of the weaker preparations.
Guide to steroid cream and ointment application
1 fingertip length = ½ gram (1FTU)
4 year old child
| Area | Grams |
|---|---|
| Face and Neck | 1½ |
| Trunk (front and back) | 2½ |
| Upper limb | ½ |
| Lower limb | 1 |
| Hands and feet | 1 |
Adult
| Area | Grams |
|---|---|
| Face and Neck | 1½ |
| Trunk (front and back) | 7 |
| Upper limb | 1½ |
| One hand | ½ |
| Lower limb | 3 |
| One foot | 1 |
Patient experience
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