Topical Steroids for Children

Not all options are appropriate for young skin

Woman putting moisturizer on child

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In This Article

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 and prescription options alike.

Low-potency versions of topical steroids should be used on children whenever possible in order to minimize risks.

Topical Steroid 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—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.

Concerns for Use in Children

While topical steroids are invaluable treatments for a vast array of dermatological conditions, their use in children poses important concerns that must be considered.

Children are more apt to develop side effects of topical steroid use because of their immature skin barrier and because they have a larger surface-area-to-weight ratio than do adults (i.e., 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
  • Stretch marks
  • Enlarged blood vessels

Extra-delicate skin, such as on the face, is particularly vulnerable.

Using the lowest potency effective to treat the condition for as short a duration as possible minimizes the risk of side effects. Still, topical steroids should only be used on children if advised by a physician or pharmacist. Never use a topical steroid prescribed for somebody else on your child.

Rare Side Effects

Topical steroids suppress the hypothalamic pituitary adrenal (HPA) axis. This inhibition of the natural secretion of hormones can lead to:

Children are at greater risk of this than adults, and they can show inhibition of growth, delayed weight gain, and increased pressure inside the brain.

While reports of cases of these due to topical steroids are rare, there have been a few dozen instances in the past 50 years, as well as a couple of deaths in children.

As a result of this, expert panels are reluctant to endorse topical steroids being sold over the counter. They fear that parents don't always understand the risks when buying the drugs for at-home use.

In most cases, the effect of topical steroids on the HPA axis puts a child at minimal risk. Life-threatening complications typically only occur when a child experiences this side effect as well as stressful physiologic event, such as a trauma, surgery, or serious infection.

The effects on the HPA axis are reversible and usually return to normal within weeks.

Appropriate Topical Steroids for Children

Only certain topical steroids are actually approved by the U.S. Food and Drug Administration (FDA) for use in children.

While many other topical steroids are frequently and safely prescribed for young children, this is considered off-label use. Such topical steroids have little safety data when used in children, so a doctor may only consider them if other options have been tried without success.

Over-the-Counter Hydrocortisone

Over-the-counter hydrocortisone is a very low-potency steroid. It is useful for short-term treatment of skin issues such as mild eczema, insect bites, and other minor skin irritations.

It comes in strengths of 0.5% to 1% and can be found in both cream and ointment forms at your local drugstore. Brands include Cortizone and Cortaid.

OTC hydrocortisone products are officially approved for children as young as 2 years of age, but can be used in infants under the recommendation and supervision of a pediatrician.

Synalar (Fluocinolone)

Fluocinolone is a mild steroid commonly used to treat eczema, psoriasis of the scalp, and seborrhea. 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 of age. Use should not exceed four weeks.

Desonate (Desonide)

Desonide is a low-potency 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 is approved for those as young as 3 months of age. It can be used nearly anywhere, including the face.

Dermatop (Prednicarbate)

Prednicarbate is somewhat more potent than the aforementioned topical steroids, and it's considered a lower mid-strength medication. It's often recommended for eczema, psoriasis, and allergic skin rashes.

Prednicarbate is approved for children as young as 1 year of age and can be used on sensitive areas, such as the face.

Cutivate (Fluticasone Propionate)

Cultivate is a moderately potent steroid. It is most often prescribed to treat eczema, especially moderate cases of dermatitis or rashes that don't resolve with the use of less potent topical steroids.

This medication is approved for children as young as 3 months of age.

Elocon (Mometasone)

Elocon is used to treat eczema and psoriasis. The ointment form is much more potent than the cream. Your child's physician will decide which is most appropriate.

Elocon is approved for children as young as 2 years of age.

Triamcinolone

Triamcinolone isn't FDA-approved for use in children, but it is commonly used off-label to treat eczema, psoriasis, and other types of dermatitis. Triamcinolone can be mild to fairly potent, depending on the brand and form used.

How to Use Topical Steroids on Children

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 are needed, which will vary depending on the area to be covered and the age of your child. 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 does is 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 doctor know if you notice:

  • Increased redness or rash
  • Stretch marks
  • Darkening of the skin
  • Bruising

You should always bring up any other changes that are concerning to you as well.

A Word From Verywell

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.

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Article Sources

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