Topical corticosteroid (potent — Nerisone 0.1%; very potent — Nerisone Forte 0.3%) Pregnancy: Use sparingly — large surface area or prolonged use can cause systemic absorption with theoretical fetal effects. Mild–moderate potency preferred.

Diflucortolone valerate

Brand names: Nerisone, Nerisone Forte (oily 0.3%)

Adult dose

Dose: Apply thinly OD–BD to affected area; reduce frequency as condition improves. Maximum continuous use: face 5 days; body 2 weeks (potent); 1 week (very potent). Total amount: face/neck no more than 30 g/week (potent).

Route: Topical

Frequency: Once or twice daily

Apply sparingly with finger-tip unit (FTU) measurements: 1 FTU covers 2 adult palms. Stop or step-down when symptoms controlled. Do not use under occlusion unless specialist-instructed.

Paediatric dose

Route: Topical

Frequency: OD–BD

Use cautiously in children (greater systemic absorption per kg). Avoid Nerisone Forte in children. Limit area and duration. AVOID prolonged use on face, axillae, groins.

Clinical pearls

Potency hierarchy: hydrocortisone 1% (mild) < clobetasone 0.05% (mod) < betamethasone valerate 0.1% / diflucortolone 0.1% (potent) < clobetasol 0.05% / diflucortolone 0.3% (very potent).
Useful for refractory eczema, lichen planus, psoriasis (excluding face/flexures), discoid lupus.
Step-down approach: control flare with potent agent for 7–14 days, step down to milder potency, then maintenance with twice-weekly application of mid-potency agent ('weekend therapy').
Face/flexures: use mild only (hydrocortisone 1%); reserve potent for severe disease under specialist advice — AND limit to days, not weeks.
Counsel about thinning skin: it occurs gradually but can be irreversible after months of unmonitored use.
Topical steroid withdrawal/'red skin syndrome' — counsel against abrupt cessation in chronic users.

Contraindications

Untreated bacterial, viral, or fungal skin infection (can mask and worsen)
Acne vulgaris
Rosacea, perioral dermatitis (can precipitate or worsen)
Tuberculosis or syphilitic skin lesions
Hypersensitivity

Side effects

Skin atrophy (epidermal thinning, telangiectasia, striae) — most common with prolonged use, esp. flexural sites
Steroid-induced rosacea, perioral dermatitis (face)
Hypopigmentation (especially in darker skin)
Hypertrichosis (local hair growth)
Topical infections — masking of fungal/bacterial
Rebound flare on abrupt discontinuation (red skin syndrome — chronic facial use)
Glaucoma, cataracts (from facial use near eyes)
Systemic absorption: HPA axis suppression (with very large body-surface use, occlusion, infants)

Interactions

Other topical preparations: avoid simultaneous application — apply at different times

Monitoring

Skin response and signs of atrophy
Long-term: HPA axis if extensive area / very potent / under occlusion

Reference: BNFc; BNF 90; SmPC Nerisone / Nerisone Forte; BAD Topical Steroid Guidance; NICE CKS Eczema. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways