The Rule of Hand: 4 Hand Areas=2 FTU=1 g

Abstract

In January 1990, multiple glossy, slightly erythematous, infiltrated plaques developed; these plaques had violaceous borders on the ab¬ domen, the back, and both legs ( Figure). The patient was still being treated with prednisone (10 mg/d) and chloroquine (100 mg/d). His¬ tologie examination of a skin lesion showed a thickened dermis with a homogeneous stratum papillare; some dilated capillaries; and coarse, bundled collagen. These findings confirmed our clinical diag¬ nosis of morphea.Thus, 1 year after EF was diagnosed in our patient, the multiple plaques of morphea developed.Comment.-Some authors identify EF as a separate disease entity,3 while others consider it to be a variant of scleroderma.4While EF clearly differs from scleroderma in clinical pic¬ ture and laboratory findings, the histologie similarities be¬ tween the two are conspicuous. The dermal change in sclero¬ derma is that of thickening caused by broad, elongated, swollen collagen bundles, which are oriented parallel to the surface epithelium. In EF, the dermal collagen can be mildly sclerotic. In EF, inflammation and fibrosis is seen in the subcutis and underlying fascia.2 In scleroderma, the earliest his¬ tologie findings are inflammation of subcutaneous tissue and fibrosis.5 Since fascial thickening is not seen in scleroderma, a full-thickness biopsy specimen helps to distinguish the two processes.The coincidence of scleroderma and EF also suggests a re¬ lationship between the two disorders, as has been illustrated in a review of 52 patients with EF, 15 (29%) of whom had lo¬ calized morphea.1 In addition, several patients have been de¬ scribed in whom progressive systemic sclerosis and EF de¬ veloped concomitantly and in whom multiple plaques of morphea and EF coexisted.

Area of skin disease can be used to indicate amount of treatment needed

“…We were therefore interested in RJ Perry and colleagues' findings,1 which closely agree with ours 2. We compared the area of one side of a hand (with the fingers and thumb pulled together) with the calculated body surface area in 50 adults and found that the hand represented a mean of 0.76% of the body surface area in men and 0.70% in women.…”

“…We compared the area of one side of a hand (with the fingers and thumb pulled together) with the calculated body surface area in 50 adults and found that the hand represented a mean of 0.76% of the body surface area in men and 0.70% in women. This information was used to devise the “rule of hand,” a simple method for determining the amount of topical treatment to prescribe 2. The rule states that four (adult) hands is equivalent to 1 g or two fingertip units 3.…”

Guidelines for management of atopic dermatitis

“…However, when using medium rank topical corticosteroids, twice‐a‐day application is more effective than once‐a‐day application (evidence level II) 33 Application amount of topical corticosteroids: A finger‐tip unit (FTU) is the amount of ointment expressed from a tube with a 5‐mm diameter nozzle and measured from the distal skin‐crease to the tip of the index finger (∼0.5 g); this is an adequate amount for application to two adult hand areas, which is approximately 2% of an adult body surface area 34,35 …”

The weight of a finger-tip unit of ointment in 5-gram tubes

“…Lastly, we consider that it is appropriate to consider 1 FTU = 0.25 g (4 FTU = 1 g) but not 1 FTU = 0.5 g (2 FTU = 1 g) when prescribing steroid ointments in 5-gram tubes (2). Moreover, the 'rule of hand', that states 1 FTU of ointment covers the area of two handprints (3), should be reconsidered when prescribing ointments packed in such small tubes with small nozzles.…”