Topical Steroid Ladder
PAs currently cannot independently prescribe topical corticosteroids. Always consult your supervising GP or prescribing clinician. This ladder is intended as a decision-support and revision aid.
Mild Potency
Examples: Hydrocortisone 0.5-1%
Common uses: mild eczema, nappy rash, facial inflammation, intertrigo
Primary care note: often available OTC; suitable for short-term use in sensitive areas. Check for response in 5-7 days.
Moderate Potency
Examples: Eumovate (Clobetasone butyrate 0.05%)
Common uses: eczema not responding to mild steroids, lichen simplex, seborrhoeic dermatitis
Primary care note: not for use on face or genitals. Review after 7-14 days. Always apply a thin layer.
Potent
Examples: Betnovate (Betamethasone valerate 0.1%), Elocon (Mometasone furoate 0.1%)
Common uses: Psoriasis (non-facial), discoid lupus, lichen planus, severe eczema
Primary care note: limit use to thickened plaques or lichenified areas. Max 2-4 weeks per course.
Very Potent
Examples: Dermovate (Clobetasol propionate 0.05%)
Common uses: resistant psoriasis, chronic hyperkeratotic eczema, severe lichen planus
Primary care note: requires strict supervision. Only use in short bursts (1-2 weeks max). Avoid on face. Refer if unclear or poor response.
If symptoms worsen, there is skin thinning, infection develops, or there's poor response after 2-4 weeks of appropriate use - discuss with supervising clinician and consider dermatology referral.
- NICE CKS. Eczema - atopic.
- British National Formulary (BNF). Topical corticosteroids. Available at: bnf.nice.org.uk