As we all know the BNF advises corticosteroid creams to be used once or bd if needed. In practice I've seen a lot of Rxs for tds (especially for milder steroids such as hydrocortisone).
Could someone please shed some light on this. Are there any reasons why doctors might be prescribing it tds rather than bd? also is there data to support the fact that bd use may significantly reduce the risk of skin thinning as opposed to tds?
I am aware that some doctors seem to think skin thinning associated with steroids is a myth, which i totally disagree with as I have seen the effects on some patients with my very own eyes.
i particularly noticed this pattern of prescribing in worcestershire where almost every single Rx for a steroid cream indicated tds usage.
One 15g tube of HC 1% used tds until finished will not 'thin the skin' GP is right, it's a myth, unless extended prescribing, which the pharmacist should probably have picked up, as GP is probably, as usual, an eejit.
Can be used THREE times a day. As the product is to be used up to twice a day by the manufacture it would go against the product license (i think)
I usually advise patients to start of twice a day. Can then increase to three times a day if they do not notice a significant improvement with a few days. Personally i think twice a day would be more than enough.
Depends on the type corticosteroid and the PMR. Hydrocortison or clobetasone, I'd be fine with. If it's clobetasol then there would be alarm bells. (Although I have come across a doctor who felt it was okay to prescribe clobetasol cream for vaginal thrush, despite the patient having not tried anything else yet. Don't you just love it when you query a horrible dose and it feels like you've trodden on Dr Pride's toes?)
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