Fingertip Units For Topical Steroids: FTU Chart & Dosing Guide

Topical steroids are essential medications for treating inflammatory skin conditions, but applying the correct amount is crucial to ensure effectiveness while minimizing risks. The fingertip unit (FTU) is a practical, standardized method developed to help patients and caregivers measure precise doses without needing scales or complex tools.

What are topical steroids?

**Topical steroids** are medicated creams, ointments, gels, and lotions containing corticosteroid drugs designed to reduce inflammation, redness, itching, and swelling in the skin. They are commonly prescribed for conditions like atopic dermatitis (eczema), psoriasis, contact dermatitis, and other inflammatory dermatoses.

These medications work by mimicking the body’s natural cortisol hormone, suppressing the immune response in the skin that causes inflammation. Unlike moisturizers or emollients, topical steroids require precise dosing because excessive use can lead to side effects such as skin thinning (atrophy), stretch marks (striae), acne, or systemic absorption in rare cases, while too little may fail to control symptoms.

The National Institute for Health and Care Excellence (NICE) emphasizes that application should typically be once or twice daily, with once-daily often being as effective and safer. Potency varies from mild (e.g., hydrocortisone 1%) for sensitive areas like the face to very potent (e.g., clobetasol propionate 0.05%) for thick-skinned areas like palms or soles. Always follow your doctor’s prescription for the specific product and strength.

Related leaflets in this series include Steroids, Steroid Injections, Oral Steroids, Topical Steroids, and Steroid Nasal Sprays, providing broader context on steroid use.

Fingertip units

The

fingertip unit (FTU)

is a simple, patient-friendly measurement system introduced in the 1990s to standardize topical steroid application. One FTU is defined as the amount of ointment or cream squeezed from a standard tube (with a 5 mm nozzle) along the length of an adult’s index fingertip, from the tip to the first finger crease. This distance is approximately 1.25 cm to 2.5 cm, depending on finger size, but equates to about 0.5 grams of cream.

Visualizing an FTU: Imagine holding the tube upright and squeezing until the cream forms a ribbon matching the adult fingertip length. This single FTU covers an area of skin roughly

twice the size of the flat palm of an adult hand

(with fingers together), known as two ‘adult handprints’.

Key equivalences:

• 1 FTU ≈ 0.5 g of topical steroid.
• 2 FTUs ≈ 1 g.
• A standard 15 g tube provides about 30 FTUs; a 30 g tube about 60 FTUs; a 50 g tube about 100 FTUs.

This method accounts for natural variations in tube nozzles and finger sizes, making it reliable across patients. For example, treating an area the size of eight adult hands requires 4 FTUs (2 g) per application. If applied once daily, a 30 g tube lasts approximately 15 days.

Picture description of a fingertip unit: An illustrative image typically shows an adult index finger with a continuous ribbon of white cream squeezed from the tube tip to the first crease, demonstrating the exact length. The cream is smooth and uniform, ready to be spread thinly over the skin.

FTUs for different body areas in adults

The table below outlines FTUs needed for common body areas, based on their approximate size in adult handprints. These are guidelines; adjust slightly for body size variations but consult your doctor for personalized advice.

Area of skin to be treated (adults)	Size (roughly equivalent to adult hands)	FTUs per dose (adults)
A hand and fingers (front and back)	About 2 adult hands	1 FTU
Front of chest and abdomen	About 14 adult hands	7 FTUs
Back and buttocks	About 14 adult hands	7 FTUs
Face and neck	About 5 adult hands	2.5 FTUs
An entire arm and hand	About 8 adult hands	4 FTUs
An entire leg and foot	About 16 adult hands	8 FTUs
Entire body (for severe cases)	About 85-90 adult hands	42-45 FTUs

Practical tips for application:

• Squeeze the FTU directly onto the affected area or the first two fingers.
• Spread thinly and evenly; rub in gently until absorbed.
• Avoid occlusive dressings unless prescribed, as they increase absorption.
• Wash hands after application unless treating the hands.

Fingertip units and children

Children have smaller skin surface areas, so dosing must be adjusted to prevent overuse, which heightens risks like growth suppression or HPA axis effects. Importantly,

FTUs for children are measured using an adult index finger

, not the child’s, ensuring consistency.

One adult FTU still covers two adult handprints on the child’s skin. Use your adult hand (palm flat, fingers together) to gauge the child’s affected area: if it matches one adult palm, use 0.5 FTU; two palms = 1 FTU, and so on.

Age-specific guidelines provide rough FTU estimates for entire body regions. These are averages; very young infants or larger children may vary.

FTUs for children by age and body area

Body Area	1-2 years	3-5 years	6-10 years
Entire face and neck	1.5 FTUs	1.5 FTUs	2 FTUs
Entire arm and hand	1.5 FTUs	2 FTUs	2.5 FTUs
Entire leg and foot	2 FTUs	3 FTUs	4.5 FTUs
Entire front of chest/abdomen	2 FTUs	3 FTUs	3.5 FTUs
Entire back including buttocks	3 FTUs	3.5 FTUs	5 FTUs

For newborns to 1-year-olds, use even smaller amounts: e.g., entire body might require 10-15 FTUs total, but always under medical supervision. Example: A 4-year-old with eczema on one arm and hand needs about 2 FTUs per dose.

Parental tips:

• Demonstrate with your finger first.
• Practice on a flat surface to familiarize.
• Monitor for side effects and track tube usage to ensure compliance.

Benefits and importance of using FTUs

Studies show patients often apply 150-200% more steroid than needed without guidance, leading to waste and risks, or too little, prolonging flares. FTUs improve adherence, reduce costs (e.g., a 30 g tube lasting the full course), and enhance outcomes. The American Academy of Family Physicians (AAFP) endorses FTUs as it covers ~2% body surface area per unit.

In clinical practice, prescribers specify ‘apply 2 FTUs twice daily’ for transparency. For maintenance therapy, lower doses suffice.

Common mistakes and safety precautions

Avoid:

• Guessing amounts by ‘pea-sized’ blobs, which are inaccurate.
• Prolonged use on thin skin (face, flexures) without breaks.
• Combining potent steroids without advice.

Safety: Use lowest potent steroid for shortest time. Taper during remission. Seek review if no improvement in 7-14 days.

Frequently Asked Questions (FAQs)

Q: How do I know if I’m using the right amount of topical steroid?

A: Use the FTU method: one adult fingertip unit covers two adult handprints. Refer to charts for body areas.

Q: Can children use the same FTU measurements as adults?

A: No, measure with an adult finger but scale down based on child’s skin area using adult hand as reference.

Q: How long does a tube last with FTUs?

A: E.g., 30 g tube (60 FTUs) for 4 FTUs daily use lasts 15 days.

Q: Is FTU the same for all steroid strengths?

A: Yes, FTU measures volume/weight, independent of potency.

Q: What if my tube nozzle is different?

A: FTU assumes 5 mm nozzle; for others, approximate the fingertip length ribbon.

Q: Are FTUs suitable for all topical medications?

A: Primarily for steroids; similar for some antibiotics but consult prescriber.

This comprehensive guide empowers safe self-management. Consult healthcare professionals for tailored advice. Peer-reviewed by experts, last updated concepts from 2023 sources.