Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Topical corticosteroid (potent — Nerisone 0.1%; very potent — Nerisone Forte 0.3%) Pregnancy: SPC section 4.6: There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormalities in foetal development including cleft palate and intra-uterine growth retardation. There may, therefore, be a very small risk of such effects on the human foetus and, as a general rule, topical preparations containing corticoids should not be applied during the first trimester of pregnancy. In particular, application to large areas of the body or for prolonged periods must be avoided. Side effects cannot be excluded in neonates whose mothers have been treated extensively or for a prolonged period of time during pregnancy or while lactating (for example, reduced adrenocortical function, when applied during the last weeks of pregnancy). Nursing mothers should not be treated on the breasts.

Diflucortolone valerate

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

Diflucortolone valerate is a potent topical corticosteroid used for inflammatory and pruritic dermatoses such as psoriasis and resistant eczema.

Adult dose

Dose: Topical treatment of corticoid-responsive dermatoses that are unresponsive to less potent corticosteroids and in the absence of infection (Nerisone Cream, 0.1 g diflucortolone valerate per 100 g cream; adults): apply thinly twice daily initially; when the condition improves or when longer periods of treatment are required, one application daily is appropriate
Route: Topical (cream applied thinly to the skin)
Frequency: Twice daily initially; once daily when the condition improves or when longer treatment is required. Long-term continuous therapy should be avoided, usual maximum duration 4 weeks; if used on the face, courses limited to 5 days and no occlusion
PRODUCT (SPC section 2): NERISONE CREAM (PL191150004, Meadow Laboratories Limited) - '100g cream contains 0.1g diflucortolone valerate'. NOT COVERED BY THIS SOURCE: the page also lists Nerisone Forte (oily 0.3%, very potent) - this SPC is for the 0.1% cream only, so no dose is written for Nerisone Forte or for the oily cream / ointment forms (section 4.2 only says to switch to a form containing more fat - Nerisone Oily Cream or Nerisone Ointment - if the skin dries out too much under protracted use of the cream). VERBATIM section 4.2 (adults): 'Initially, Nerisone should be applied thinly twice daily. When the condition improves or when longer periods of treatment are required one application daily is appropriate. Long-term continuous therapy with topical corticosteroids should be avoided, with a usual maximum duration of 4 weeks. If used on the face, courses should be limited to 5 days and occlusion should not be used (see section 4.4).' No maximum quantity per week and no finger-tip-unit instruction is printed in the SPC, so none is written. Elderly: natural thinning of the skin occurs in the elderly; no special precautions are required when Nerisone is used in this group (section 4.2). Occlusive dressings: may be called for in unusually refractory cases and usually under specialist supervision; if an infection develops under the dressing, occlusive treatment must be terminated (section 4.2). Section 4.4: each occlusive dressing should not be left on for more than 24 hours; if occlusive treatment is expected to be prolonged, it is advisable to change the dressing every 12 hours; systemic corticoid absorption and the risk of adrenal suppression are increased under occlusion; adrenal suppression can occur even without occlusion. Nerisone Cream is suitable for weeping skin conditions and for moist, exposed and hairy areas of the body (section 4.2). Do not allow contact with the eyes (section 4.4). Corticosteroid class/potency wording is not printed in the SPC and is not added here.

Paediatric dose

Dose: Children 1-4 years of age: apply thinly twice daily; use with great care, for short periods and generally only on the advice of a doctor specialising in dermatology. Children 5 years of age and over: initially apply thinly twice daily; when the condition improves one application daily is appropriate. Not to be used in children under 1 year of age.
Route: Topical (cream applied thinly to the skin)
Frequency: 1-4 years: twice daily, courses limited to 5 days. 5 years and over: twice daily initially, then once daily when the condition improves; courses limited to 1-2 weeks (if used on the face, 5 days). No occlusion in 1-4 years.
THE LABEL'S OWN STATEMENTS, NOT SCALED. VERBATIM section 4.2: 'Children 1-4 years of age: Nerisone should be applied thinly twice daily. It should be used with great care, for short periods and generally only on the advice of a doctor specialising in dermatology. Courses should be limited to 5 days and occlusion should not be used. Children 5 years of age and over: Initially, Nerisone should be applied thinly twice daily. When the condition improves one application daily is appropriate. Courses should be limited to 1-2 weeks. If used on the face, courses should be limited to 5 days and occlusion should not be used. Nerisone should not be used in children under 1 year of age.' Section 4.4: 'If used on children up to the age of 4 years or on the face, courses should be limited to 5 days and occlusion should not be used.' Adrenal suppression can occur even without occlusion. Napkin eruptions are a contraindication (section 4.3). Verify against a children's formulary / specialist advice before use.

Dose adjustments

Renal

No renal dose adjustment is printed in the retrieved SPC sections.

Hepatic

No hepatic dose adjustment is printed in the retrieved SPC sections.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Rosacea and peri-oral dermatitis
  • Acne vulgaris, undiagnosed perianal and genital pruritus, napkin eruptions
  • Viral infections, primary bacterial or fungal infections of the skin
  • Secondary infections in the absence of appropriate anti-infective therapy
  • Post vaccination skin reactions in the area to be treated
  • Not suitable for the treatment of ophthalmic conditions
  • Hypersensitivity to the active substances or to any of the excipients
  • Children under 1 year of age - section 4.2: Nerisone should not be used

Side effects

  • Common local adverse reactions: burning, pruritus, erythema and irritations
  • With application to large areas of the body (10% or more) and for long periods (more than four weeks), especially under an occlusive dressing: local atrophy of the skin, telangiectasia, striae, acneform changes, perioral dermatitis and hypertrichosis
  • Systemic corticoid effects caused by absorption, including features of hypercorticism and possible suppression of natural steroid production, especially with occlusive dressings
  • Rare: allergic skin reactions
  • Adrenal suppression can occur even without occlusion (section 4.4)
  • Glaucoma may develop with local corticoids (e.g. after large doses or extensive application over a prolonged period, occlusive dressing technique or application to the skin around the eyes) (section 4.4)
  • Allergic contact dermatitis due to topical corticosteroids and excipients can occur (section 4.4)
  • Exacerbation of skin infections may occur (section 4.4)

Interactions

  • None stated (SPC section 4.5)

Monitoring

  • Careful patient supervision is important in psoriasis: topical corticosteroids may be hazardous (rebound relapses following development of tolerance, risk of generalised pustular psoriasis, local and systemic toxicity due to impaired barrier function) (section 4.4)
  • Infections or secondarily infected dermatoses require additional therapy (antibiotics or chemotherapeutic agents; a topical antimycotic if fungal infection is present) (section 4.4)
  • If aggravation of skin irritation develops, withdraw treatment and install appropriate therapy (section 4.4)
  • If eczema fails to improve or deteriorates, consider allergic contact dermatitis; corticosteroid hypersensitivity is most frequent in stasis dermatitis and leg ulceration and should be corroborated with patch testing (section 4.4)
  • Adrenal suppression and systemic effects: avoid long-term continuous therapy (usual maximum 4 weeks irrespective of age); take particular care with occlusion, children, and large areas (section 4.4)
  • If the skin dries out too much under protracted use of the cream, switch to a form which contains more fat (section 4.2)

Clinical monograph

How it works

It binds glucocorticoid receptors in the skin to suppress inflammatory mediators and immune activity and to produce local vasoconstriction.

Prescribing in practice

  • As a potent steroid it can cause skin atrophy and, with extensive or prolonged use, systemic absorption and HPA-axis suppression, so apply sparingly for the shortest effective period.
  • Use with caution on the face and flexures and avoid occlusion unless specifically directed, as occlusion increases absorption.
  • Step down to a less potent steroid once the flare is controlled and reassess if there is no improvement.

Monitoring

Monitor the treated skin for local steroid effects and, with widespread or prolonged use, for features of systemic corticosteroid exposure.

Counselling the patient

  • Apply a thin layer to affected skin only and avoid the face unless told otherwise.
  • Do not stop suddenly after prolonged use; follow the stepping-down plan.
  • Report skin thinning, stretch marks or worsening of the rash.

Evidence & guidelines

Use follows established topical corticosteroid potency principles and NICE guidance on using the lowest effective potency for eczema and psoriasis.

Reference: SmPC Nerisone / Nerisone Forte; BAD Topical Steroid Guidance; NICE CKS Eczema; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways