Write the quantity, not just the strength, and then compare what was dispensed against what should have been used. Roughly 30 g covers the whole adult body once; treating both hands twice daily for two weeks needs about 30 g; a face needs about 15 g for the same fortnight. A patient returning with an untouched 100 g tube and an unchanged rash has an adherence problem, not a potency problem - and a patient going through 100 g a month of a potent steroid on a limited site needs a different conversation.
The fingertip unit is the version that survives translation to the clinic: one fingertip of cream from an adult index finger treats an area about the size of two flat adult palms. Give the number of fingertip units per application and the tube size together, and the quantity does the counselling for you.
It also catches the common failure that looks like resistant disease: too little, too infrequently, stopped early. Before stepping up potency or reaching for a systemic agent, establish that an adequate quantity of an adequate steroid was actually applied for an adequate time.
- Specify grams and tube size on every topical steroid prescription
- Teach fingertip units with the patient's own hand, for the actual site being treated
- At review, ask how much of the tube is left - it is the cheapest adherence measure available
- Suspect underuse, not resistance, when a rash is unchanged and the tube is nearly full
- Flag repeat quantities of potent steroid that exceed the site's plausible requirement
Why it matters
Most apparent topical steroid failure is a quantity problem, and nobody finds it without asking about the tube.
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