Hydrocortisone 2.5% Should Not Be Applied to a Child's Sunburned Face
Topical corticosteroids, including 2.5% hydrocortisone, should not be applied to a child's face with sunburn as there is insufficient evidence supporting their efficacy for sunburn treatment, and they carry risks of adverse effects in pediatric patients.
Evidence on Topical Corticosteroids for Sunburn
Efficacy in Sunburn Treatment
- A randomized, double-blind study found no significant difference in sunburn symptom resolution between fluocinolone cream and inert carrier base when applied to naturally acquired sunburn 1
- While a later study showed some benefit of topical corticosteroids (methylprednisolone aceponate and hydrocortisone 17-butyrate) for sunburn in adults 2, this evidence doesn't outweigh the risks in children
Risks in Pediatric Patients
- Children, especially those under 6 years, are particularly vulnerable to adverse effects from topical corticosteroids due to their high body surface area-to-volume ratio 3
- The face is especially susceptible to corticosteroid-induced adverse effects, including:
- Skin thinning/atrophy
- Telangiectasia (especially on cheeks)
- Local irritation
- Altered skin barrier function
Alternative Approaches for Facial Skin Conditions in Children
For Inflammatory Facial Conditions
- Topical calcineurin inhibitors (TCIs) are recommended as the preferred first-line therapy for facial skin conditions in children 4
- Tacrolimus 0.1% ointment is specifically recommended for off-label use as monotherapy for pediatric facial conditions 4
For Sunburn Management
- Avoid frequent washing with hot water 4
- Use alcohol-free moisturizers, preferably with 5-10% urea content 4
- Avoid additional skin irritants 4
- Minimize sun exposure and use appropriate sun protection (SPF 15 or higher) 4
Important Considerations for Pediatric Dermatologic Care
- When treating inflammatory skin conditions in children, potent topical corticosteroids should be used with caution and patients should be followed closely by a dermatologist 4
- For facial applications in children, lower potency corticosteroids are generally preferred if corticosteroids must be used at all
- Careful instruction on the amount to apply and safe sites for use should be provided, with limited quantities supplied 4
Conclusion
For a child with facial sunburn, focus on supportive care with gentle moisturizers, avoiding further sun exposure, and maintaining adequate hydration. If anti-inflammatory treatment is needed, consult a dermatologist who may consider alternatives to corticosteroids that are safer for facial use in children.