OSCE Toolbox | Hydrocortisone Cream Request - Scenario

By Leya Luhar • April 20, 2026 • Last reviewed: 2026-04-20 •

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Summary Beginner

In this scenario, a community pharmacist receives an over-the-counter request for hydrocortisone 1% cream from a patient with a poison ivy rash. The student must take a relevant history, confirm if the supply is appropriate, and explain the management plan.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this scenario.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

Mark Scheme

Introduction

0 / 2

Introduces self as the pharmacist with an appropriate greeting

+1

Confirms patient details (name and age)

+1

History Taking

0 / 8

Asks who the product is for

+1

Confirms the cream is for David himself, an adult. Supply of OTC hydrocortisone cream is appropriate for adults and children aged 10 and over

Asks what the symptoms are

+1

Itchy, red rash on the forearm following contact with poison ivy. Student should establish the nature, location, and appearance of the rash

Asks how long the symptoms have been present

+1

Symptoms started yesterday evening. Important to establish onset and duration to confirm this is an acute, self-limiting reaction appropriate for OTC management

Asks what action has already been taken

+1

No treatment taken yet. Students should ask whether the patient has already used other products to avoid concurrent, prolonged or duplicate use.

Confirms medication history

+1

David takes no regular medications. Important to confirm no other topical corticosteroid use

Confirms the rash is not on the face, genitals, or broken or infected skin

+1

OTC hydrocortisone cream should not be used on the face, on infected or broken skin, or on large areas of the body - student must actively establish this before supplying

Confirms allergies and nature of any reaction

+1

No known drug allergies - student should ask specifically about allergy to hydrocortisone or any ingredients in the cream

Confirms no contraindications to supply

+1

No rosacea, no psoriasis, no untreated skin infection at the site — these are all listed contraindications per the PIL. Student should actively screen for these

Supply Decision

0 / 1

Confirms the supply is appropriate and explains rationale

+1

Mild, localised allergic contact dermatitis on the forearm in an adult with no contraindications - OTC hydrocortisone 1% cream is an appropriate supply

Counselling Using the PIL

0 / 8

Explains what the hydrocortisone cream is and how it works in patient-friendly terms

+1

e.g. “This is a mild steroid cream - it works by reducing the inflammation and irritation in your skin, which is what’s causing the redness and itching.”

Explains the correct dose and frequency

+1

Apply thinly and sparingly to the affected area two to three times daily — per the PIL

Explains the importance of applying sparingly and only to the affected area

+1

Using too much or applying to large areas increases the risk of side effects such as skin thinning

Advises the patient not to use the cream on the face, genitals, or broken skin

+1

Per the PIL — use on the face or in skin folds increases the risk of skin thinning and hormonal side effects with prolonged use

Advises on maximum duration of use

+1

The cream should not be used continuously for a long period — if symptoms have not improved within one week, the patient should seek further advice from a pharmacist or GP

Counsels on the fire hazard warning

+1

Per the PIL — patients should not smoke or go near naked flames while using the cream, as fabric that has been in contact with the product is a fire hazard. This is a commonly missed but important counselling point

Advises on at least one additional measure to help manage symptoms

+1

e.g. cool compresses to soothe itching, avoiding scratching to prevent skin damage or infection, washing the affected area and any clothing that may have contacted the plant

Mentions at least one possible side effect to look out for

+1

e.g. skin rash, increased redness or itching that could indicate an allergic reaction - patient should stop using the cream and seek advice if this occurs. Other side effects include skin thinning with prolonged use

Safety Netting

0 / 3

Advises the patient to see their GP if symptoms worsen or do not begin to improve within one week

+1

Advises the patient to seek urgent medical attention if they develop signs of a severe allergic reaction

+1

e.g. swelling of the face, lips, tongue or throat, difficulty breathing or swallowing - these are signs of anaphylaxis and require emergency treatment

Advises on future prevention - avoiding contact with the plant and wearing protective clothing when gardening

+1

Contact dermatitis from poison ivy is caused by urushiol oil - future episodes can be prevented by identifying and removing the plant or covering arms and hands when gardening

Communication and Professionalism

0 / 4

Uses appropriate, jargon-free language throughout

+1

Checks patient understanding throughout the consultation

+1

Concludes the consultation professionally, summarising key points and offering to answer further questions

+1

The student did not say anything that could harm the patient

+1

This includes supplying without taking an adequate history, failing to identify a contraindication, or providing incorrect counselling advice that could put the patient at risk

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1