Which Topical Steroids Are Better for Children?

Woman putting moisturizer on child
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Topical steroids are commonly used by people of all ages, including children. Topical steroids are effective for the treatment of atopic dermatitis (eczema), contact dermatitis (including rashes caused by poison oak and ivy), itchy forms of dry skin, and other causes of itching, including insect bites.

However, topical steroids can have long-lasting side effects, particularly with the use of higher potency versions. Therefore, when topical steroids are used on children, low potency versions should be used whenever possible in order to minimize side effects.

Topical Steroids Approved by the FDA

Only certain topical steroids are actually approved by the U.S. Food and Drug Administration (FDA) for the use of children. All of these, with the exception of hydrocortisone, are available only by prescription. These include, listed in order of increasing level of potency (weakest to strongest):

  • Over-the-Counter Cortizone/Cortaid (hydrocortisone) 0.5 percent and 1 percent cream and ointment, approved for children as young as 2 years of age.
  • Derma-Smoothe (fluocinolone) 0.01 percent oil, approved for children as young as 3 months of age.
  • Desonate/Verdeso (desonide) 0.05 percent gel/foam, approved for children as young as 3 months of age.
  • Dermatop (prednicarbate) 0.1 percent cream, approved for children as young as 1 year of age.
  • Cutivate (fluticasone propionate) 0.05 percent cream, approved for children as young as 3 months of age.
  • Elocon (mometasone) 0.1 percent cream and ointment, approved for children as young as 2 years of age.

While many other topical steroids are frequently and safely prescribed for young children, such as triamcinolone, it must be realized that these topical steroids have little safety data when used in children, and therefore are considered "off FDA indication" use.

Safety Concerns

Topical steroids suppress the hypothalamic-pituitary-adrenal (HPA) axis. This inhibition of the natural secretion of hormones can lead to Cushing's syndrome, high blood sugar, and spilling glucose in the urine. Children are at greater risk than adults and they can show inhibition of growth, delayed weight gain, and increased pressures inside the brain. While reports of cases of these due to topical steroids are rare, there have been a couple dozen cases in the past 50 years and 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 wouldn't understand the risks when buying the drugs to use at home. While in most cases the effects of topical steroids on the HPA axis means only the child is at minimal risk, if they undergo a stressful physiologic (rather than psychologic) event such as trauma, surgery, or serious infection, they might have life-threatening complications. The effects on the HPA axis are reversible and usually return to normal within weeks.

A Word From Verywell

The bottom line is to treat topical steroids with respect and use them as prescribed and only as recommended by your doctor and pharmacist. There may be other options to use for your child. Using the lowest potency of topical steroids is effective to treat the condition, and only using it for the recommended length of time, are the basic tenets of safety. Never use a topical steroid prescribed for somebody else on your child.

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