What is a safe moderate potency topical corticosteroid (steroid) for pediatric patients?

From the Guidelines

Fluticasone or mometasone are considered safe moderate potency topical corticosteroids for pediatric patients. These medications are recommended for use in children with moderate to severe atopic dermatitis (AD) as part of a proactive therapy approach, applied twice weekly to previously affected skin areas for up to 16 weeks to help prevent relapses 1. When selecting a topical corticosteroid for pediatric patients, it's crucial to consider the potency and potential for adverse effects, such as skin atrophy, especially in highly sensitive skin areas like the face, neck, and skin folds.

• Key considerations for the use of topical corticosteroids in pediatric patients include:
  • Potency: Low to medium potency corticosteroids, such as fluticasone or mometasone, are preferred for longer-term use or for treatment of chronic AD involving the trunk and extremities.
  • Application frequency and duration: Twice-weekly application for up to 16 weeks is recommended for proactive therapy.
  • Skin area: High potency corticosteroids should be used with caution in sensitive areas, while lower potency options are preferred for infants and young children due to the increased risk of adrenal suppression.
• It's essential to instruct parents on the proper use of topical corticosteroids, including applying the minimum effective amount, using the medication for the recommended duration, and following up if the condition doesn't improve or worsens during treatment, as indicated by the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1.

From the FDA Drug Label

Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity

Safe moderate potency topical corticosteroid in pediatric patients is not explicitly stated in the provided drug labels. However, based on the information provided, hydrocortisone butyrate 2 and triamcinolone acetonide 3 are both topical corticosteroids, but their safety for pediatric patients depends on various factors such as the dose, duration of use, and individual patient characteristics.

• Key considerations for pediatric patients include:
  • Greater susceptibility to HPA axis suppression and Cushing's syndrome
  • Potential for systemic toxicity due to larger skin surface area to body weight ratio
  • Need for limited administration to the least amount compatible with an effective therapeutic regimen
  • Potential impact on growth and development with chronic corticosteroid therapy It is essential to consult a healthcare professional for specific guidance on the safe use of topical corticosteroids in pediatric patients.

From the Research

Safe Moderate Potency Topical Corticosteroids for Pediatric Patients

• The choice of a safe moderate potency topical corticosteroid for pediatric patients depends on several factors, including the diagnosis, the steroid's delivery vehicle, potency, frequency of application, duration of treatment, and side effects 4.
• A study comparing a short burst of a potent topical corticosteroid with a mild preparation for children with mild or moderate atopic eczema found that both treatments were equally effective 5.
• For pediatric atopic dermatitis, topical corticosteroids are used as first-line anti-inflammatory treatment, and the therapeutic efficacy depends on selecting the appropriate vehicle and potency, as well as the frequency of application and duration of treatment 6.
• A 36-month follow-up study comparing the safety of topical tacrolimus with topical corticosteroids (mild and moderate potency) in young children with atopic dermatitis found that both treatments were safe and had comparable efficacy and safety profiles 7.
• Examples of moderate potency topical corticosteroids that may be suitable for pediatric patients include:
  • Triamcinolone 0.1% ointment
  • Betamethasone 0.1% cream
  • Hydrocortisone 2.5% ointment Note that the choice of topical corticosteroid should be individualized based on the specific needs of the patient and the guidance of a healthcare professional 8.