Clinical and Experimental Dermatotogy 1991; 16: 444 447.

The finger-tip unita new practical measure

C.C.LONG AND A.Y.FINLAY Department of Dermatology, University of Wales College of Medicine, Cardiff

Accepted for publication 22 March 1991

Summary Thirty dermatology in-patients, 16 males (aged 18-71

years, mean 43 6 s.d. + 17 5) and 14 females (aged 16-75
A finger-tip unit (FTU) is the amount of ointment years, mean 3714 s.d.+ 18 5), were invited to enter the
expressed from a tube with a 5 mm diameter nozzle., study. These patients had either eczema or psoriasis and
applied from the distal skin-crease to the tip ofthe index were conversant with the application of topical medica-
finger. Thirty adult-patients treated various anatomical tion.
regions using FTU's of ointment. The number of FTU's
required was: face and neck 2-5 (s.d. 0-8); front of trunk The length of the tips of their index fingers were
6-7 (s.d. 1-7); back of trunk 6-8 (s.d. 1-2); arm and measured; measuring from the distal skin-crease to the
forearm 33 (s.d.+ 10); hand 1-2 (s.d. 0 4); leg and end of the finger.
thigh 58 (s.d.1-7); foot 1-8 (s.d.0-6). One FTU Each patient was shown how to plaee a finger-tip unit
covers 286 cm^ (s.d.+ 80, K 30). In males one FTU of betamethasone 0 025% ointment from a tube with a 5
covers 312 em^ (s.d.+90, n 16) and in females 257 cm^ mm diameter nozzle onto the palmar aspect of one index-
(s.d.+ 55, n= 14). The u.se ofthe FTU in dermatological finger (Fig. 1). The patient was then asked to apply the
prescribing provides a readily understandable measure ointment so as to cover a circular area of skin on the
for both patients and doctor. abdomen, and to spread the ointment evenly throughout
the circle to cover as large a circular area as the patient felt
appropriate.
The outer edge of the treated area was then outlined
Dermatological prescribing and the instructions given to with a skin marker-pen by the investigator (C.L.). A
a patient concerning the application of topical therapy are transparent plastic-sheet (old X-ray film) was placed on
often imprecise as the doctor may not know how much the abdomen and the outline of the treated area was
ointment or cream is required to cover different hody- traced. The outline was then re-traced from thefilmonto
areas. In addition the patient rarely knows how much graph paper and the outlined area measured. This gave
weight of ointment or cream he should squeeze from the the area covered by one FTU for that patient.
tube before applying it.
Each patient was then asked to apply ointment using
We have described' a practical measure, the 'Finger- FTU's to areas previously delineated by a skin marker-
Tip Unit' (FTU) as a simple means of allowing doctors pen. The areas treated were: the front ofthe chest and
and patients to communicate better about treatment abdomen, the back ofthe trunk (including buttocks), one
application. A finger-tip unit (FTU) is the amount of
ointment expressed from a tube with a 5 mm diameter
nozzle, applied from the distal skin-crease to the tip ofthe
palmar aspect of the index finger; this is approximately
0-49 g in males and 0-43 gin females.' The purpose of this
study was to provide information concerning the number
of finger-tip units required to treat difierent areas of the
body.

Methods
Ethical approval was granted by the local Joint Medical
Ethics Committee of the University Hospital of Wales
and informed consent obtained from each patient.

Correspondence: Dr C.C.Long, Department of Dermatology, mmlO 2O 3O

University Hospital of Wales, Heath Park, CardiflXI'H 4XW, Wales,
U.K. Figure I. One fingertip unit.

444
 THE FINGER-TIP U N I T 445

upper-arm and forearm, one hand, one leg, one foot and
the face, neck and ears.
The number of FTU's required to treat each anatomi-
cal area was recorded.

Results
and Neck 2^/2 FTU
The average area of abdominal skin covered by one FTU
was 286 cm^ (s.d. 80, w 30). In males the average area
was 312 cm^ (s.d. 90, H ^ 1 6 ) and in females it was 257
cm^ (s.d.55, -14). Front 7 FTU

The average length of each finger-tip in males was 2 6 Back 7 FTU

cm (s.d.0-15, =16) and in females 2 4 cm (s.d.0-1,
n= 14). The number of FTU's required to treat different 3 FTU
anatomical areas is given in Table 1.
Figure 2 provides a more easily remembered practical
guide to the number of FTU's required for different 1FTU
One Hand
areas. These approximate figures are derived from the
data in Table 1.
The nominal weight of ointment required to treat the
different anatomical sites is calculated from the data in
Table 2, taking the average weight of one FTU as 0 49 g
in males and 0 43 g in females. The approximate total-

2 FTU
Table 1. Mean number of tingertip units (FTU) required to treat
anatomical regions

Both sexes Males I'emales

Mean s.d. Mean + s.d. Mean + s.d.
(w-30) in=\b) (-]4)
Front of trunk 67+1-70 6-9175 6-4+l'6
Back of trunk 6 8l-2 6-6l'O 7-0l-4 Figure 2. Number of fingertip units required to treat various
(including buttocks) anatomical sites once. Mean for both sexes (to nearest half FTU).
Leg 5-8+1-7 5-9 1-8 57+1-53
Foot l-8 + l)'6 ]-8n-8 17 + ()-4.S weight of ointment required for twice daily application
Arm and forearm 3-3l-() 3-4 0-92 3-1 0-98
Hand l'2t)4 1 3 + 0-46 M+0'26 for 1 week for an adult male is shown in Figure 3.
Face, neck and ears 2-50'8 27 0-9 2-20-56 Approximately 282 g would be required for twice daily
application to the total body-surface (except the scalp) for
1 week.

Table 2. Nominal calculated-weight (g) of

ointment required for diti^erent anatomical- Discussion
areas derived from FTU data (one
FTU-t)-49 g for males, and 043 g for Maurice and Saihan' assessed the weight of ointment
females) used when applied sparingly to patients by nursing staff.
In that study it required an average of 1 -07 g of ointment
to treat one arm of an adult male, 2-1 g to treat a leg and
xMales Females
4-2 g to treat the trunk (front and back). In the present
Front of trunk 34 2-8 study where the ointment was applied by the patients
Back of trunk 3'2 3'0 themselves under medical supervision, the figures were
Leg 2'9 2-5 1-7 g, 2 9 g and 6-6 g respectively, this suggests that
Foot 0-9 07 patients tend to apply more ointment to themselves than
Arm and forearm 17 1-3 when it is applied for them by nursing staff.
Hand 0'6 tl-5
Face, neck and ears i^ 0'9 Maurice and Saihan reported that it takes an average of
121 g to treat the complete skin-surface of an adult male.
 446 C.C.LONG AND A.Y.FINLAY
were applied twice daily for one week. The standard
British Dermatology reference book,'' recommends a
figure of 100 g as a .suitable quantity for whole-body
treatment for 1 week when used sparingly and between
250-500 g when applied liberally. No mention is made of
Face and Neck application frequency. The British National Formulary''
quotes 445-690 g as being suitable quantities for whole-
body treatment, for between 2-4 weeks, warning that
topical corticosteroids should be applied more sparingly.
Trunk Front 4 ^ Again no mention is made of frequency of application.
Back 45g
If the number of FTU's required to treat particular
anatomical regions are expressed as a percentage of the
One arm 24g total required to treat the whole body (except the scalp),
then it takes 8 3% to treat one arm, 14 4% to treat one leg,
16-8% to treat the front ofthe trunk, and 16% to treat the
back of the trunk (including the buttocks).
One Hand Lund and Brow der*^ in their paper on the estimation of
the areas of burns quote an arm as representing V*^^,, a leg
16-5'^,,, the front of the trunk 13% and the back
(including the buttocks) 18%, of the total body surface-
Leg 40.5g area. Thus our figures give a slightly smaller percentage
to the leg and the back ofthe trunk but a slightly larger
percentage to the arm and front of the trunk. These
differences may be due to variation in the amount of
ointment applied by patients to difierent regions or may
One foot 12.5g be due to inaccuracy in the original estimation of surface
area. Lund and Brow der's paper w as an attempt to refine
the figures produced by several earlier workers and was
not based on any direct measurements of their own.
The length ofthe finger-tip ofthe index finger, and the
weight of an FTU shows little variation between indi-
viduals ofthe same sex.' Our findings for finger-tip length
Figure 3. Nominal weight of ointment required for an adull male to were similarly consistent. Thus an FTU is a convenient,
treat region twice-daily tor 1 week. reliable and reproducible quantity.
The use of the FTU in dermatological prescribing
enables patients to have a readily understood measure of
This average figure is similar to the minimum quantities how much ointment is to be applied; patients can he asked
quoted by other workers.' ' We found however, that the to apply a given number of FTU's to the affected areas.
mean 'nominal weight' for whole-body treatment of an Already one pharmaceutical company provides pads of
adult male was 20-1 g. In an earlier study' in which patient information sheets hased on the FTU. The
patients were also asked to apply the treatment them- problem of communication with patients could be further
selve.s the results were similar to ours. In that study, eased if pharmaceutical companies could package their
patients who had been 'well instructed' and who applied preparations in containers which dispensed known units
the treatment 'sparingly and without excess', the range of of weight (say 0-5 or 1-0 g) of ointment of cream. In the
weights required for total-body treatment of an average meantime however, by regularly using the FTU concept,
adult male was from 121-26-6 g with a mean of 17-8 g. doctors can now prescribe topical medication more
Furthermore, the weight of medication required to treat accurately for their patients.
the whole body or specific parts was the same for both
ointments and creams. This suggests that the tinger-tip
unit measurements given above may be equally valid for References
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specifically measured this. It remains possible that there Dermatology. Eancel 1989; 11: 155.
may be slightly different spreading properties of creams. 2. Maurice POl,, Saihan FG. Topical steroid requirement in
We calculate that it would take 281 4 g of ointment to inflammatory .skin conditions. British Journat of Ctinicat Practice
1985; 39: 441 442.
treat the whole body (except scalp) of an adult male if it 3. Schlagel CA, Sanhorn EG. The weights of topical preparations

required for total and partial body inuncUan. Journal of Invesliga-
live Dermalotogy 1964; 42: 253-256.
4. Katz i\l. Drug Design In: AriensFJ,ed.M^i/iniJ'/C7/f/i.v/o', New
York: Academic Press, 1973: 117.
5. Polano MK. Topicat Skin Therapeutics, Edinburgh: Churchill
Livingstone, 1984: 142-143.
6. Griffiths WAD, Ive FA, Wilkinson JD. Topical therapy. In: Rook
THE FINGER-TIP U N I T 447
A, Wilkinson DS, Lbling FJG <-//. eds. Textbook of Dermatotogy,
Oxford: Blackwell Scientific Puhlications, 1986: 2542.
7. British National Formulary No. t9. London: British Medical
Association and the Royal Pharmaceutical Society ol Great Britain,
1990: 376.
8. Lund CC^, Browder NC. The estimation of areas of hums. Surgery,
Cynaecotogy and Obstetrics 1944; 79: 352-35S.