Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids

Topical corticosteroids form the mainstay of treatment for many skin conditions. If used appropriately, they are safe and effective, and side-effects are generally uncommon. Current advice to patients to apply topical corticosteroid preparations 'sparingly' or 'thinly' contributes to 'steroid phobia', increasing the risk of poor clinical response and treatment failure. Such cautionary advice also overlooks the fact that the vast majority of patients are prescribed topical corticosteroids of mild potency for which the evidence suggests that the risk of harm is minimal. In the patient's mind, the current advice groups all steroids together regardless of their potential for adverse effects. The advice also tends to reinforce an erroneous concern that the risks from topical corticosteroids may be similar to those from systemic corticosteroids. We propose a change to make the pharmacy labelling of topical corticosteroids more accurately reflect the low risk of harm from corticosteroids of low to moderate potency and the importance of applying sufficient medication to achieve a satisfactory clinical response. This change could provide the focus for updated, evidence-based education for healthcare professionals in prescribing of topical corticosteroids and help in the provision of more appropriate advice to patients. We recommend that patients are informed that treatment should not exceed prescribed quantities, and continuing treatment should be under careful medical supervision. We also recommend that topical corticosteroid products include clear 'fingertip unit' instructions, preferably with images of a 'fingertip unit' and a chart to show the number of units required for specific areas of the body.