Page 7 - Rash Talk Magazine - Issue - One

Potent Steroids: Under Watch Video:

Occlusion vs Cream Steroid Plaster SAMPLE IMAGES
How to apply a

by Polly Buchanon, Clinical Editor,

Dermatological Nursing

Holistic assessment is continually encouraged in dermatology medicated plasters are individually packaged in foil, which
nursing. This article takes the opportunity to reflect on topical can be reclosed for future use and supports hygienic use.
corticosteroid (TCS) prescribing and the considerations to be
made when deciding how and what formulation to prescribe. Nature, extent and distribution
In particular, focus will be placed on the pros and cons of of inflammatory condition
prescribing potent topical corticosteroids, ‘open application’
versus ‘under occlusion’ . During assessment, the nature, extent and distribution of the
skin condition is considered. TCS creams and ointments are
Topical corticosteroid applications remain the mainstay of suitable for widespread inflammatory skin conditions such as
treatment for many chronic inflammatory skin conditions. eczema and psoriasis. However, in difficult to treat or localised
There are three important considerations when deciding areas, often a TCS under occlusion or impregnated plaster can
what to prescribe: provide sustained TCS delivery, enhancing rapid resolution
1. Patient understanding and concordance and patient experiences. The plaster can be cut to size and
applied to isolated lesions, digits, palms, soles and joints.
2. Nature, extent and distribution of inflammatory condition
3. Joint decision-making. Joint decision-making
Traditionally, TCS applications are openly applied to the skin Following a holistic assessment and discussion, a joint
using a reducing regimen. Creams and ointments can be decision to treat with a potent TCS is made with the patient.
messy, sticky, and cumbersome to apply. In recent years, Consider safety, effectiveness and patient centred-ness.
there has been the development of fixed dose applications This will include financial costs and benefits of each product
within medicated plasters and tapes. whether it be TCS open application or under occlusion.
Patient understanding and concordance The table highlights the key considerations with TCS
under occlusion and open application.
There remains considerable steroid phobia with patients and
health professionals. This can lead to skin conditions being Potent Steroid Potent Steroid
Cream
under-treated. Yet we must ensure any topical treatment is Plaster (alone/under bandage)
safe, effective and person-centred. Metered dose/24hr release ✔ ✘
Therefore, always consider what TCS would be clinically Targeted application
effective and would suit the patient’s ability and lifestyle. ✔ ✘
Alongside a daily emollient programme, always consider Helps patient compliance ✔ ✘
a TCS treatment plan that is uncomplicated and simple to Manages risk of under/overdose ✔ ✘
apply, preferably once daily. Twice daily applications of TCS Won’t rub off ✔ ✘
creams or ointments can be forgotten or omitted due to time
constraints. A fixed dose medicated TCS plaster, such as Individually packaged ✔ ✘
Betesil 2.250 mg medicated plaster, or tape delivers a constant Quick to apply ✔ ✔
medication release for 12-24 hours, which avoids over or under- No preparation needed ✔ ✔
dosing. Reduction in frequency of application can effectively
wean the patient off the TCS as the skin condition resolves. Protection of lesion ✔ ✘
Cross contamination has been an issue with fingertip Does not stain clothes/bedding ✔ ✘
application of topical creams and ointments over time, Widely known/understood ✘ ✔
which can be a hygiene concern for patients. Betesil 2.250 mg Visit Betesil.co.uk to access prescribing information for Betesil 2.250 mg medicated plaster

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