Topical steroids are often used for children in the treatment of many types of skin rashes, including atopic dermatitis (eczema) and contact dermatitis, as well as itchy dry skin and insect bites. While effective, special care must be taken when selecting these drugs for and using them on kids, as they are more apt to develop side effects. This applies to both over-the-counter (OTC) and prescription options alike.
As a general rule, low-potency topical steroids should be used on children whenever possible in order to minimize risks.
Efficacy and Potency
Topical steroids are one of the most commonly prescribed dermatological drugs among all age groups. They work by stopping chemical reactions at the cellular level, reducing inflammation—and, therefore, redness and itchiness—and allowing the person to be more comfortable as their skin heals.
Topical steroids are grouped by potency into classes, from Class 1 (most potent) to Class 7 (least potent). Those in Classes 6 and 7 are usually most appropriate for children.
While topical steroids are invaluable treatments for a vast array of dermatological conditions, their use in children poses specific risks and concerns.
Children are more apt to develop side effects because their skin is thinner and they have a larger surface-area-to-weight ratio than adults (meaning that they are more likely to absorb larger amounts of the medication through the skin).
Common side effects of topical steroid use include:
- Thinning of the skin (cutaneous atrophy)
- Stretch marks (striae)
- Enlarged blood vessels (telangiectasias)
Extra-delicate skin, such as on the face, is particularly vulnerable. Using the lowest potency formulation for the shortest period to time minimizes the risk of side effects.
Rare Side Effects
Topical steroids suppress the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is a system of endocrine organs—the hypothalamus, pituitary gland, and adrenal glands—that interact with each other to regulate the production of hormones and body processes such as digestion, metabolism, immune function, and mood.
The suppression of the HPA axis and hormone production can lead to conditions such as:
While cases of steroid-induced HPA suppression are rare, they are more likely to occur in infants and the elderly due to the increased absorptive capacity of their thinner skin. Diseased skin can also pose risks since the barrier function of the skin may be severely compromised. In such cases, even small doses of a potent topical steroid may produce side effects.
As a result, health regulators remain reluctant to approve most topical steroids for OTC use, fearing that parents and guardians won’t understand the risks or how to use the drugs properly.
Only a handful of topical steroids are approved by the U.S. Food and Drug Administration (FDA) for use in children.
While there are many others often used safely in kids (such as the prescription drug triamcinolone), their use is still considered off-label. In most cases, a healthcare provider will only turn to these when other options have been tried without success.
Of the topical steroids officially approved by the FDA for use in children, only one is available over the counter.
Over-the-counter hydrocortisone is a very low-potency steroid. It is useful for short-term treatment of skin conditions such as mild eczema, insect bites, and other minor skin irritations.
Topical hydrocortisone comes in strengths of 0.5% to 1% and can be found in both cream and ointment forms at your drugstore. Brands include Cortizone and Cortaid. OTC hydrocortisone products are officially approved for children ages 2 and over but can be used in infants under the supervision of a pediatrician.
Fluocinolone is a mild prescription steroid commonly used to treat eczema, scalp psoriasis, and seborrhea (dandruff). It comes in oil, cream, and ointment forms. Brand names include Synalar and Derma-Smoothe, with the former being slightly more potent than the latter.
Fluocinolone is approved for children as young as 3 months, although its use should not exceed four weeks.
Desonide is a low-potency prescription steroid used to treat various types of dermatitis. It comes in cream, foam, and gel forms, and is sold under brand names Desonate and Verdeso.
Desonide is one of the most commonly prescribed topical steroids for children and approved for those as young as 3 months of age. It can be used nearly anywhere on the body, including the face and eyelids.
Dermatop (prednicarbate) is a somewhat more potent topical steroid available by prescription only. Considered a lower mid-strength topical steroid, It is often recommended for the treatment of eczema, psoriasis, and allergic skin rashes.
Prednicarbate should not be used on children younger than 10 years of age and should not be used on sensitive areas of skin, such as the face.
Cutivate (Fluticasone Propionate)
Cultivate (fluticasone propionate) is a moderately potent steroid available by prescription only. It is most often prescribed to treat eczema, especially moderate cases of dermatitis or rashes that don’t resolve with less potent topical steroids.
This medication is approved for children 1 year and older and should be used for no longer than four weeks due to the risk of HPA suppression.
Elocon (Mometasone Furoate)
Elocon (mometasone furoate) is a potent topical steroid available by prescription that is used to treat eczema and psoriasis. The ointment form is much more potent than the cream and should never be applied to more than 20% of the total body surface area.
Elocon is approved for children as young as 2 years of age and used once daily. Generally speaking, Elocon should be used for no longer than 3 weeks.
Diflorasone diacetate is classified as a Class 1 topical steroid. Available by prescription, it is approved for use in children but should be used with extreme caution. Brand names include Psorcon, Apexicon, and Maxiflor.
Topical diflorasone is generally not recommended for use in children under 12 years of age, except where the benefits of treatment outweigh the potential risks.
Cordran (flurandrenolide) is a Class 1 topical steroid available by prescription. Although less potent topical steroids are generally preferred in children, a short course of Cordan may help relieve severe eczema on the arms or legs.
There is also flurandrenolide-infused tape that can be used for occlusive therapy, allowing the drug to better penetrate tissues. Each square centimeter of Cordran tape delivers 4 micrograms (mcg) of flurandrenolide.
Most topical steroids are applied once or twice daily to the affected areas. Ideally, you’ll apply them shortly after bathing your child.
The most common way to measure the amount of medication needed is by fingertip unit (FTU). This measurement is exactly what it sounds like: the amount of medication that covers the finger from its tip to the first joint.
Your child’s pediatrician will tell you how many FTUs of a drug are needed, which will vary based on your child’s age and the surface area of skin requiring treatment.
For example, to treat the face of a 3-month-old infant, 1 FTU will suffice. To fully cover an entire leg of a 6-year-old, a 4 FTU dose may be more appropriate.
Wherever the topical steroids are applied, make sure to rub them in completely. You can apply a moisturizer over the top if needed.
Discontinue use and let your child’s healthcare provider know if you notice:
- Increased redness or rash
- Stretch marks
- Darkening of the skin
Always advise your healthcare provider about any side effects or changes to the skin your child may be experiencing, however mild.
A Word From Get Meds Info
Even though you can get some topical steroids over the counter, these (and all drugs) should be treated with respect. Use them only if recommended by a healthcare professional and as directed. There may be other options that can be used on your child that yield similar results.