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The weight of a finger-tip unit of

ointment in 5-gram tubes
October 2011 · Journal of Dermatological Treatment 22(5):302-
3
DOI:10.3109/09546631003797098
Source · PubMed

Authors:

Itaru Dekio
The Jikei University School of Medicine

Eishin Morita

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Journal of Dermatological Treatment. 2011; 22: 302–303

LETTER

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

ITARU DEKIO* & EISHIN MORITA

Clinic for Atopic Dermatitis, Department of Dermatology, Faculty of Medicine, Shimane University, 89-1 Enya-cho,
Izumo 693-8501, Japan

Sirs, We weighed the exact amount of 1 FTU of three

The concept of a finger-tip unit (FTU), first coined by
Finlay et al. in 1989 (1), is now widely accepted for
specifying the amount of ointment that is used for the
treatment of dermatoses. Finlay et al. reported that 1
FTU (Figure 1) of ointment in 5-mm nozzle tubes
weighs 0.49 g for males and 0.43 g for females.
However, in Japan, topical steroids are marketed in
much smaller packages (5-gram tubes) than those
in western countries. The outlets of such tubes are
smaller nozzles; therefore, 1 FTU of ointment
obtained from such tubes weighs less than that
obtained from tubes used in western countries.
Knowing the exact weight of 1 FTU from such tubes
is essential for dermatological practice in Japan, but
no study has looked into this issue.
steroid ointments in 5-gram tubes that are commonly
prescribed in Japan (Figure 2, Table I). The inner
diameter of the nozzles varied between ointments
(3.4–4.2 mm). When we applied the length of the
distal phalanx of the index finger as 2.69 ± 0.18 cm for
males (n = 49) and 2.52 ± 0.18 cm for females (n = 47)
in reference to the unpublished data on healthy Jap-
anese of Prof. M. Kouchi, 1 FTU was found to weigh
0.25–0.31 g for males and 0.23–0.29 g for females.
A.

B.

Figure 2. Measurement of a finger-tip unit. (A) An unsqueezed

5-gram tube of ointment. (B) Measurement of the length of the
squeezed lines of ointment, and a tube squeezed using a plastic
Figure 1. A finger-tip unit. squeezer (Taney, Tokyo, Japan).

*Correspondence: Itaru Dekio, Department of Dermatology, Faculty of Medicine, Shimane University , 89-1 Enya-cho, Izumo 693-8501, Japan.
Fax: +81 853 21 8317. E-mail: dekio@mx2.et.tiki.ne.jp

(Received 11 January 2010; accepted 22 February 2010)

ISSN 0954-6634 print/ISSN 1471-1753 online  2011 Informa Healthcare USA on behalf of Informa UK Ltd.
DOI: 10.3109/09546631003797098

The weight of a finger-tip unit of ointment in 5-gram tubes 303

Table I. Measurement of a finger-tip unit (n = 3).

Weight of
Trade name Inner diameter squeezed ointment Length of Weight
(manufacturer) Ingredient of nozzle (mm) per tube (g) ointment line (cm) per FTU (g)

Antebate ointment Betamethasone butyrate 3.8 4.82 ± 0.05 46.9 ± 10.9 0.277
(Torii) propionate 0.05% (17.4 FTU)

Dermovate ointment Clobetasol propionate 0.05% 3.4 4.66 ± 0.03 50.2 ± 3.9 0.250
(GlaxoSmithKline) (18.6 FTU)
Rinderon VG ointment Betamethasone valerate 0.12% 4.2 4.75 ± 0.03 41.0 ± 1.5 0.312
(Shionogi) supplemented with (15.2 FTU)
gentamicin sulfate 0.1%

The length of a fingertip was considered to be 2.69 cm for this calculation.

FTU = finger-tip unit.

Furthermore, to determine the relationship between
the diameter of nozzle and the weight of a FTU, we
performed the following calculation using a scheme
shown in Figure 3 (where D = diameter of syringe-
shaped ointment, L = length, and r = density):
(section area) = π ( D/2)2 = ( π/4) D 2
(volume) = L × (section area) = (π/4) LD2
(weight) = ρ × ( volume ) = ( π/4) r L × D2
This theoretical calculation shows that the weight of a
finger-tip unit is in proportion to a square of the diam-
eter. That is to say, the relationship of the weight and the
diameter can be described in the following formula:
(weight of 1 FTU) = A × D 2 ,
where A is a constant defined by the concentration of
ointment and the length of a finger-tip and D is the
diameter of the syringe-shaped ointment (inner diam-
eter of the nozzle).
With regard to our data and the report of Finlay et al.
(1), when we consider the length is fixed to 2.5 cm and
concentrations are the same in the UK and in Japan, 1
D r
FTU for a 5-mm diameter nozzle is 0.49 g, that for
a 4.2-mm diameter nozzle is 0.29 g, and that for a
3.4-mm diameter nozzle is 0.23 g. So the constant A is
calculated by the substitution of this formula:
0.49 = A × 52 , 0.29 = A × 4.2 2 , 0 .23 = A × 3.4 2
A ≈ 0.02.
In this context, the weight is easily estimated as
follows:
1 FTU (g) = A × D2 ≈ 0.02 ×
( inner diameter of the nozzle, mm)2 .
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 hand-
prints (3), should be reconsidered when prescribing
ointmentspackedin suchsmalltubeswith smallnozzles.
Acknowledgement
We thank Prof. Makiko Kouchi, Digital Human
ResearchCenter,NationalInstituteofAdvancedIndus-
trial Science and Technology, for providing us with his
unpublished data on the length of the distal phalanx of
the index finger of a healthy Japanese population.

D/2
L
Figure 3. Scheme for calculation of the weight of a finger-tip unit of
ointment, where D is the diameter (i.e. the inner diameter of the
nozzle) of syringe-shaped ointment; L and r are length and density,
respectively.
References
1. Finlay AY, Edwards PH, Harding KG. “Fingertip unit” in
dermatology. Lancet. 1989;15(8655):155.
2. Long CC, Finlay AY, Averill RW. The rule of hand: 4 hand
areas = 2 FTU = 1 g. Arch Dermatol. 1992;128:1129–1130.
3. Kalavala M, Mills CM, Long CC, Finlay AY. The finger-tip
unit: A practical guide to topical therapy in children.
J Dermatolog Treat. 2007;18:319–320.

Citations (4) References (5)

... Topical corticosteroids (TCSs) are important anti-

inflammatory drugs for managing AD, especially
during acute flares. TCS recommendations are
summarized in Table 6 4,5,64,[73][74][75][76][77]
[78] [79] . TCSs significantly improve AD lesions
compared to placebo 73,74 . ...

... The fingertip unit (FTU) is commonly suggested,

as it has been found that the amount of TCS from
the distal skin crease to the tip of an adult patient's
index finger is equivalent to approximately 0.5 g
TCS. Using 1 FTU of TCS, applying the amount on
the surface area of the two palms of the patient is
appropriate (Fig. 1) 78 . Application of TCSs
should be tapered if signs of inflammation
disappear 79 . ...

... During flare-ups, active topical anti-inflammatory

treatment should be primarily considered. "1 FTU"
is a useful tool that can be used to explain to AD
patients the adequate amount of topical anti-
inflammatory agent to apply 78 . Even after the AD
lesions disappear, patients with frequent relapsing
disease courses require proactive treatment with
TCSs or TCIs [3][4][5]9 . ...

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