1. Appropriate use and potential side effects of TCS
Zinc Code: UK/RET/0122/16b
Date of Prep: November 2016
  Appropriate use and potential side effects of TCS
As pharmacists, you can support the patient with advice on how to best use the TCS they have been prescribed, as well as information on the side effect profile of these therapies.

2. The fingertip unit is a well-established measure for TCS application
Zinc Code: UK/RET/0122/16b
Date of Prep: November 2016
The fingertip unit is a well-established measure for TCS application
One adult fingertip unit (FTU)
Amount of ointment or cream expressed from a tube with a standard 5mm diameter nozzle
Age
Face and neck
Arm and hand
Leg and foot
Trunk (front)
Trunk (back including buttocks)
Adults
2.5 4 8 7
Children
3–6 months 1
1.5
1–2 years 2 3
3–5 years
3.5
6–10 years
4.5 5
One fingertip unit
Ensure patient is aware of the different FTUs required based on age and location of disease*
TCS quantities are generally measured in fingertip units – this is a simple and relatively consistent way to measure the amount of TCS being used on a particular area
The age of the patient and location on the body affects the number of FTUs needed – it’s important that the patient uses the correct amount to address the symptoms while limiting the potential for adverse effects
Reference
NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016
*Guidance regarding how TCS should be used will be provided by the prescribing physician, and patients should be reminded of these specific recommendations
NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016.

3. Systemic side effects with TCS are rare
Zinc Code: UK/RET/0122/16b
Date of Prep: November 2016
Systemic side effects with TCS are rare
TCS can cause local and systemic side effects; local side effects are more common1
Fear of side effects can lead to undertreatment2
Factors affecting the risk of systemic side effects include:3–6
Potency and formulation, occlusive dressings, duration of exposure, surface area of application, location (e.g. thin skin areas, broken skin), and age as children are at higher risk
Should be used with caution in patients with a history of hypersensitivity to other corticosteroids3–6
Local side effects3–6
Skin thinning
Wrinkling
Dryness
Atrophy
Stretch marks
Visible blood vessels,*
Rash
Hives
Redness
Pigmentation changes
Excessive hair growth
Allergic contact dermatitis
Pustular psoriasis
Systemic side effects3–6
HPA axis suppression
Cushing’s syndrome
Hypersensitivity
Opportunistic infection
Most patients are prescribed TCS with mild potency, which carry a minimal risk of harm2
TCS use can be associated with both local and systemic effects,1 but mild-potency TCS are generally considered to be low risk2
TCS should be used with caution in:2-4
Selected locations on the body, including the scrotum and groin, face, underarms and eye area
Children and older adults
Different TCS vehicles may have a varying ability to penetrate the skin, and different potencies will influence the likelihood of side effects4
TCS use over time should be monitored
References
NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016.
Rubel D, et al. J Dermatol 2013; 40:160–171.
Eichenfield LF, et al. J Am Acad Dermatol 2014; 71:116–132.
Ference JD, et al. Am Fam Physician 2009; 79:135–140.
1. NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 2. Bewley A, et al. Br J Dermatol 2008; 158:917–920; 3. Cutivate cream. UK Summary of Product Characteristics, February 2014; 4. Betnovate cream. UK Summary of Product Characteristics, Sept 2013; 5. Dermovate cream.
UK Summary of Product Characteristics, Nov 2014; 6. Eumovate cream. UK Summary of Product Characteristics, March 2014.

4. Zinc Code: UK/RET/0122/16b
Date of Prep: November 2016
A range of TCS potencies and formulations is available to treat AD and psoriasis
The amount of TCS to use is measured in fingertip units (FTU)1
Different numbers of fingertip units are appropriate for different ages and areas of the body1
TCS can cause both local and systemic side effects, but TCS are generally well tolerated2–5 1
It is important to be aware of the risk factors predisposing patients to side effects and to support them to use their treatment appropriately
In addition to advice on using emollients, pharmacists can provide key practical support and guidance on TCS use, including how and where to apply the formulations. It is common for patients to be prescribed a selection of TCS with different potencies; therefore, it is important that they understand which therapy should be used where, and for how long.
In case of any doubt, the patient should return to their HCP for further assessment and guidance.
1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016; 2. Cutivate cream. UK Summary of Product Characteristics, February 2014; 3. Betnovate cream. UK Summary of Product Characteristics, Sept 2013; 4. Dermovate cream. UK Summary of Product Characteristics, Nov 2014; 5. Eumovate cream. UK Summary of Product Characteristics, March 2014.