Zinc Code UKRET012216 b Date of Prep November

Zinc Code: UK/RET/0122/16 b Date of Prep: November 2016 Appropriate use and potential side effects of TCS

Zinc Code: UK/RET/0122/16 b 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 5 mm diameter nozzle Age Face and neck Arm and hand Leg and foot Trunk (front) Trunk (back including buttocks) 2. 5 4 8 7 7 1 1 1. 5 1– 2 years 1. 5 2 2 3 3– 5 years 1. 5 2 3 3 3. 5 6– 10 years 2 2. 5 4. 5 3. 5 5 Adults Children 3– 6 months One fingertip unit Ensure patient is aware of the different FTUs required based on age and location of disease* *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; http: //cks. nice. org. uk/eczema-atopic. Accessed September 2016.

Zinc Code: UK/RET/0122/16 b 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 common 1 ‒ Fear of side effects can lead to undertreatment 2 ‒ 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 corticosteroids 3– 6 Local side effects 3– 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 effects 3– 6 • • HPA axis suppression Cushing’s syndrome Hypersensitivity Opportunistic infection Most patients are prescribed TCS with mild potency, which carry a minimal risk of harm 2 1. NICE. Psoriasis. Clinical Knowledge Summaries 2014; http: //cks. nice. org. uk/psoriasis. 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.

Zinc Code: UK/RET/0122/16 b 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 body 1 TCS can cause both local and systemic side effects, but TCS are generally well tolerated 2– 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 1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; http: //cks. nice. org. uk/eczema-atopic. 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.