How to treat excessive body hair in a child after steroid use?

Management of Steroid-Induced Hypertrichosis in a 5-Year-Old Child

The most effective approach to treat excessive body hair (hypertrichosis) in a child after steroid use is to discontinue the steroid therapy if possible, as this is likely the primary cause of the condition. 1

Understanding Steroid-Induced Hypertrichosis

• Hypertrichosis is a recognized side effect of corticosteroid therapy in children, which can occur with both systemic and inhaled steroids 1
• The condition develops due to the effect of steroids on hair follicles, with time between steroid initiation and hypertrichosis varying from 1 month to 3 years 1
• Hypertrichosis may serve as a clinical indicator of exogenous steroid excess 1

Treatment Approach

Primary Intervention

• Discontinuation of steroid therapy should be the first step if medically feasible, as this addresses the root cause 1
• If steroids cannot be completely discontinued due to underlying medical necessity:
  • Consider reducing the dose to below the Cushing threshold 2
  • Evaluate alternative non-steroidal medications for the underlying condition 3

Resolution Timeline

• After steroid discontinuation, improvement in hypertrichosis may be observed in approximately 50% of cases 1
• Complete resolution may take several months, as reported cases show variable recovery periods 1
• Parents should be counseled that in some children, the excessive hair growth may not completely resolve even after steroid discontinuation 1

Topical Management Options

• Eflornithine hydrochloride cream (13.9%) can be considered for facial hypertrichosis in older children, though it's not specifically FDA-approved for pediatric use 4
  • This works by inhibiting ornithine decarboxylase, slowing hair growth rather than removing hair 4
  • Improvement is typically seen within 8 weeks of treatment initiation 4
  • Hair growth returns to pretreatment levels within 8 weeks of discontinuing treatment 4

Physical Hair Removal Methods

• For immediate cosmetic improvement, gentle physical hair removal methods may be considered:
  • Trimming or shaving (safest options for children)
  • Avoid chemical depilatories, waxing, or laser treatments in young children due to potential skin irritation and pain 3

Special Considerations for Pediatric Patients

• Children are particularly vulnerable to psychological impacts of altered appearance 3
• Provide age-appropriate explanation and reassurance about the temporary nature of the condition 3
• Consider referral for psychological support if the child shows signs of distress, withdrawal, or changes in behavior 3

Monitoring and Follow-up

• Regular follow-up to assess:
  • Resolution of hypertrichosis 1
  • Potential other signs of steroid excess (weight gain, growth retardation, adrenal suppression) 1
  • Psychological impact on the child 3

Caution

• Avoid using systemic treatments like spironolactone (an antiandrogen used for hirsutism in adults) in children, as safety and efficacy data are limited in pediatric populations 5
• Do not initiate additional steroid treatments for other conditions while addressing steroid-induced hypertrichosis 3

Remember that while the cosmetic concern is important to address, the priority should be ensuring the child's overall health by appropriately managing the underlying condition that required steroid treatment while minimizing steroid-related side effects.