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Topical Corticosteroid — Potent Pregnancy: Use with caution — avoid potent steroids on large areas in pregnancy; mild-moderate potency preferred; short courses acceptable for severe flares

Fluocinolone Acetonide (Topical)

Brand names: Synalar, Synalar N (with neomycin), Synalar C (with clotrimazole)

Adult dose

Dose: 0.025% cream/ointment — apply a thin layer to affected area
Route: Topical
Frequency: Two to three times daily (reduce to once daily once controlled)
Max: Three times daily; do not exceed 50 g/week
Potent fluorinated topical corticosteroid for eczema, psoriasis, lichen planus, and discoid lupus (scalp formulation useful for scalp eczema and psoriasis). Synalar N (with neomycin) for infected eczema. Synalar C (with clotrimazole) for eczema with secondary fungal infection. Not for face.

Paediatric dose

Dose: Apply thin layer to affected area topical/kg
Route: Topical
Frequency: Once to twice daily
Max: Limit use — avoid in children under 1 year; restrict to 5–7 days in children
BNFc: potent steroids — avoid in children under 1 year; use for shortest effective duration; face — use mild steroid (hydrocortisone 1%) instead

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: potent steroids — avoid in children under 1 year; use for shortest effective duration; face — use mild steroid (hydrocortisone 1%) instead

Clinical pearls

  • Fluocinolone acetonide 0.025% potency: equivalent to betamethasone valerate 0.1% — classified as 'potent' in UK CSM classification
  • Scalp psoriasis: Synalar gel formulation effective for scalp; combined calcipotriol/betamethasone foam (Enstilar) is now preferred for scalp psoriasis in most guidelines
  • Synalar N (neomycin): useful for infected eczema — covers Staphylococcus aureus; however, neomycin sensitisation with repeated use — consider alternatives for long-term infected eczema
  • Lichen planus: potent topical steroids are first-line for cutaneous LP — apply once daily under occlusion for oral LP (oral gel formulations preferred for mucosal LP)
  • Discoid lupus: potent and very potent steroids for scalp and body DLE; protect from sun (photosensitive condition)
  • MHRA 2021 patient information leaflet requirement: all potent topical steroids require standard information on application, area limits, and duration

Contraindications

  • Rosacea
  • Acne
  • Perioral dermatitis
  • Pruritus without inflammation
  • Viral or fungal infection (without antifungal/antiviral cover)
  • Face, genitalia, or skin folds (prolonged)

Side effects

  • Skin atrophy
  • Striae
  • Telangiectasia
  • Perioral dermatitis (face use)
  • HPA axis suppression
  • Cataracts/glaucoma (periocular use)
  • Tachyphylaxis
  • Neomycin sensitisation (Synalar N)

Interactions

  • Other topical corticosteroids — avoid concurrent use on same area

Monitoring

  • Skin atrophy at treated sites (check at every review)
  • HPA axis (if >50 g/week or large area)
  • Growth in children

Reference: BNFc; BNF 90; BNFc; BAD Topical Corticosteroid Guidelines; MHRA Drug Safety Update (2021); NICE NG10 (Psoriasis). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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