When I mention hormone ointments, patients sometimes become uncomfortable. Frequently asked questions are: isn’t it harmful, won’t it make my skin thin, will it give me a thick head? In my opinion, very valid questions and concerns. However, the correct use and with good guidance from your doctor is safe and gives a lot of improvement of complaints.
What is a hormone ointment?
Hormone ointments (corticosteroids) are substances in ointments, creams or lotions that contain a derivative form of cortisol. Cortisol is a hormone made in the adrenal glands that regulates important processes in the body. On the skin, it acts as a suppressor of inflammation such as psoriasis, eczema, lichen planus. What is often not realized is that there are different hormone classes (1 to 4), which vary in strength. Class 1 is the weakest and 4 the strongest.
How much hormone ointment should you apply?
To stay safely in the margin, we use the fingertip unit (FTE).
One fingertip unit is a line of ointment along the length of the last phalanx of the index finger. Each body part requires a certain amount of VTE for proper treatment with corticosteroid ointments. In the schedule below you can find exactly how many units you can best lubricate per body part. There is also a breakdown by age. Thus, baby skin requires comparatively fewer VTE per body part.
One fingertip unit weighs about ½ gram. About 20 grams of corticosteroid ointment is needed for the whole body in this way.
What is safe lubrication with hormone ointments?
To give you an indication of how much ointment is safe, the following guideline can be used:
- Children younger than 2 years should not use more than 30 grams per week.
- Strength: Advice class 1, exceptionally if necessary class 2.
- Children between 2 and 5 years should not exceed 50 grams per week.
- Strength: around eyes class 1, folds and face. Class 2 body.
- All ages above that are allowed a maximum of 100 grams per week.
- Strength <12 years: class 1 around eyes. Class 1-2 folds and face. Class 3 body.
- Strength <18 years: Class 1-2 around eyes, Class 2 folds and face. Class 3 body. Class 4 hands and feet.
- During pregnancy:
- Class 1 and 2 do not affect the child when used up to 100mg/week
- Rather, do not use class 3 or 4 hormone ointments for long periods of time in pregnancy. If your skin needs it, use up to 50mg/week. Futicasone (Cutivate®) and Betamethasone are then preferred.
- During breastfeeding: Do not smear hormone ointments on nipples. If you do need hormone ointments there, wash the hormone ointment off the nipples before breastfeeding.
Phase-out schedule for hormone ointment
There are several phase-out schedules and below is one possibility. Do not build off further if there is no improvement in the skin. Sometimes maintenance treatment with corticosteroid ointments remains necessary. This means that you continue to apply corticosteroid ointments 3 or 4 times a week for a longer period of time, for example.
What are the possible side effects?
To avoid side effects as much as possible, it is important that you follow the above instructions. Should this be deviated from, always do so in consultation with your physician. You then have a higher risk of these side effects:
- Thinning of skin if lubrication schedule is not adhered to.
- Increased visibility of small capillaries.
- Increase in hair growth
- Exacerbation of existing infections
- Delayed wound healing
An underexposed topic is Topical Steroid Withdrawal (TSW), more on this next week.
While you’re here
Skin repair, skin hydration, so many different products and brands available on the Internet and in stores. But what does a skin specialist look for? And what basic information is important to make the right choice. When choosing a good product, there are two things to consider.
- The base in which the product is made: lotion, grease cream, cream and ointment
- The function of the ingredients
Learn more about differences between lotions, creams and ointments