Topical Therapy for the Internist: A Practical Framework for Safer Prescribing.

Abstract

Cutaneous complaints are among the most frequent reasons adults see internists, and the great majority are treated topically. Topical prescribing, however, is seldom taught as a discipline, and predictable mistakes, such as using combination corticosteroid-antifungal creams as a diagnostic shortcut, applying a single corticosteroid potency to every body site, and writing uninformative instructions, lead to treatment failure, cutaneous and systemic adverse effects, contact sensitization, and avoidable referral. This review offers a practical prescribing framework in which morphology guides the vehicle, diagnosis guides the active drug, and site and patient factors determine potency, duration, and quantity. It summarizes the topical drug classes most relevant to internists, adult safety considerations, and seven common prescribing errors, each paired with a corrective. Two point-of-care tables and a one-page algorithm support implementation. Relevant literature was identified by searching PubMed/MEDLINE and the Cochrane Database of Systematic Reviews through May 2026 for terms related to topical therapy, corticosteroids, vehicles, and cutaneous drug safety, supplemented by specialty-society guidelines and reference lists; systematic reviews, randomized trials, guidelines, and seminal studies were prioritized in this narrative review.