From the Guidelines
For a 16-month-old child with a skin condition requiring steroid cream, a low-potency topical corticosteroid such as 1% hydrocortisone cream is generally recommended, as stated in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1. This recommendation is based on the need to minimize adverse effects, particularly in infants and young children who have an increased risk of adrenal suppression from potent topical corticosteroids (TCSs) 1. When using TCSs, it is essential to:
- Apply a thin layer to affected areas twice daily for 7-10 days
- Use the lowest effective potency
- Avoid application to the face, genitals, or skin folds unless specifically directed by a healthcare provider
- Limit the total amount to no more than 15-30 grams per week depending on the affected area size
- Reduce application to once daily for 2-3 days before stopping after improvement Regular use of emollients can also have a short- and long-term steroid-sparing effect in mild to moderate atopic dermatitis (AD), and certain moisturizers can improve skin barrier function 1. Key considerations include:
- Infants and young children should be treated with less potent TCSs than those prescribed for adults
- High potency TCSs in highly sensitive skin areas should be used with caution to avoid skin atrophy
- Proactive therapy with twice-weekly application of low to medium potency TCSs may help to prevent relapses in children with moderate to severe AD 1.
From the FDA Drug Label
INDICATIONS AND USAGE Triamcinolone acetonide cream, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. The FDA drug label does not answer the question.
From the Research
Recommended Treatment for 16-Month-Old Child with Skin Condition
The use of steroid cream for a 16-month-old child with a skin condition requires careful consideration of the potential risks and benefits.
- When prescribing topical corticosteroids for use in children, lower potencies and shorter durations should be used, as stated in the study 2.
- The study 3 compared mometasone furoate 0.1% cream and hydrocortisone 1.0% cream in the treatment of childhood atopic dermatitis, and found that mometasone furoate produced significantly greater improvement than hydrocortisone.
- Topical noncorticosteroid immunomodulators, such as tacrolimus and pimecrolimus, are also available for the treatment of atopic dermatitis, and have been shown to be effective and safe in children, as discussed in the study 4.
- A comparison of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis found that tacrolimus had statistically significant improvement in disease severity compared with weak topical corticosteroids, as reported in the study 5.
- A Cochrane systematic review and network meta-analysis of topical anti-inflammatory treatments for eczema ranked potent and/or very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% among the most effective treatments for improving patient-reported symptoms and clinician-reported signs, as stated in the study 6.
Key Considerations
- The choice of treatment will depend on the severity and extent of the skin condition, as well as the child's overall health and medical history.
- It is essential to follow the recommended dosage and duration of treatment, and to monitor the child for any potential side effects, such as skin atrophy or systemic absorption.
- Parents or caregivers should be taught how to apply the medication correctly, using the fingertip unit method, to ensure that the child receives the correct dose, as described in the study 2.