What are the guidelines for using topical corticosteroid (steroid) cream in infants?

From the Guidelines

Topical steroid creams can be used for infants with certain skin conditions, but should only be applied under a pediatrician's guidance, with low-potency steroids being the preferred choice to minimize the risk of adrenal suppression and other adverse effects. For mild conditions like eczema or diaper rash, low-potency (1% hydrocortisone) cream is typically recommended, applied in a thin layer to affected areas 1-2 times daily for no more than 7 days 1. Higher potency steroids are rarely appropriate for infants due to the increased risk of adrenal suppression. When applying, use the smallest effective amount, avoid occlusive dressings, and keep away from the eyes, mouth, and diaper area when possible.

Key Considerations

• Infants and young children with atopic dermatitis should be treated with less potent topical corticosteroids (TCSs) to avoid adrenal suppression 1.
• Low to medium potency TCSs can be used for longer periods to treat chronic AD involving the trunk and extremities, but high potency TCSs should be used with caution in highly sensitive skin areas 1.
• Parents should monitor the treated area for improvement and discontinue use if the condition worsens or if irritation develops.
• Alternative non-steroid moisturizers should be used for maintenance once the condition improves.

Application and Precautions

• Apply topical steroid creams in a thin layer to affected areas 1-2 times daily.
• Avoid occlusive dressings and keep away from the eyes, mouth, and diaper area when possible.
• Use the smallest effective amount to minimize the risk of side effects, such as skin thinning or discoloration with prolonged use.

From the FDA Drug Label

Directions for itching of skin irritation, inflammation, and rashes: ... children under 2 years of age: ask a doctor Warnings ... for the treatment of diaper rash. Consult a doctor.

For infants, topical steroid cream should be used with caution. The FDA drug label advises to ask a doctor for children under 2 years of age and for the treatment of diaper rash 2 2.

From the Research

Topical Steroid Cream for Infants

• Topical corticosteroids are an essential part of the treatment regimen for infants with atopic eczema and other inflammatory dermatoses, such as infantile seborrhoeic eczema, pompholyx, and contact dermatitis 3
• When prescribing topical corticosteroids for infants, lower potencies and shorter durations should be used to minimize the risk of adverse effects 4
• The risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4

Application and Dosage

• The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 4
• Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 4
• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 4

Safety and Efficacy

• Topical steroids have been used with great success in children since the early 1950s, and knowledge of their mode of action and development of tests of potency have added to our understanding of these agents 5
• Proactive therapy with topical corticosteroids is the standard treatment for chronic inflammatory diseases such as atopic dermatitis, but skin atrophy as a side effect remains a concern 6
• Some topical corticosteroids, such as methylprednisolone aceponate and hydrocortisone acetate, may be more suitable for repeated and prolonged treatment, especially in chronic diseases 6

Pediatric Atopic Dermatitis

• Atopic dermatitis is one of the most common chronic inflammatory skin diseases, affecting up to 25% of children, and topical corticosteroids are currently used as first-line anti-inflammatory treatment 7
• Therapeutic efficacy of topical corticosteroids depends on selecting the appropriate vehicle and potency, and the frequency of application, also taking into account the duration of treatment and patient preferences 7