Reference — Med-Surg
Topical Dermatologic Medications Reference
With topicals, how and where you apply matters as much as the drug. Match steroid potency to the site, measure with the fingertip unit, choose the right vehicle, and you prevent the two classic mistakes — under-treating and thinning the skin.
Educational use only. Potency selection, duration, and combination regimens follow dermatology and provider orders. Prolonged or high-potency steroid misuse causes skin atrophy and systemic absorption. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Corticosteroid Potency & Site
| Potency | Where it’s used |
|---|---|
| Low (e.g., hydrocortisone 1–2.5%) | Face, eyelids, skin folds, groin, and children — thin skin areas; longer-term use |
| Medium (e.g., triamcinolone) | Trunk and extremities for moderate inflammation |
| High / very high (e.g., clobetasol) | Thick plaques, palms/soles; short courses only — not on the face or folds |
Thinner skin (face, folds, children) absorbs more — use lower potency there to avoid atrophy and systemic effects.
The Fingertip Unit & Vehicle
Fingertip unit (FTU): the amount squeezed from the tip to the first crease of an adult index finger — about enough to cover an area the size of two adult palms. It standardizes “a thin layer” so patients apply enough but not too much.
Vehicle matters: ointments are most potent/occlusive (best for thick, dry, scaly skin), creams are versatile, lotions/gels/foams suit hairy or weepy areas and large surfaces. Apply to slightly damp skin after bathing for absorption.
Non-Steroid Topicals
| Agent | Use / note |
|---|---|
| Calcineurin inhibitors (tacrolimus, pimecrolimus) | Steroid-sparing for eczema; safe on the face/folds; transient burning |
| Vitamin D analogs (calcipotriene) | Psoriasis plaques; often combined with a steroid |
| Emollients / moisturizers | Foundational for eczema/psoriasis — apply liberally, especially after bathing |
| Topical antifungals (clotrimazole, terbinafine) | Tinea/candidal infections |
| Topical antibiotics/antivirals (mupirocin; acyclovir) | Impetigo; herpes labialis (limited benefit) |
| Coal tar / salicylic acid | Psoriasis scale reduction (keratolytic) |
NCLEX Pearls
- ✦Match steroid potency to the site: LOW potency on face/folds/children; high potency only short-term on thick plaques.
- ✦Prolonged/high-potency topical steroids cause skin atrophy, striae, telangiectasia, and systemic absorption.
- ✦Fingertip unit = tip to first crease, covers ~two palms — standardizes 'a thin layer.'
- ✦Ointment > cream > lotion for potency/occlusion; apply to damp skin after bathing.
- ✦Calcineurin inhibitors are steroid-sparing and safe on the face/folds; emollients are foundational.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →