Which is stronger, Mometasone (mometasone furoate) or Eleuphrat (fluocinolone acetonide), for a 5-year-old child?

Fluocinolone Acetonide (Eleuphrat) is Stronger than Mometasone for a 5-Year-Old Child

Fluocinolone acetonide is classified as a high-potency topical corticosteroid, while mometasone furoate is classified as a medium-potency agent, making fluocinolone the stronger steroid. 1, 2

Potency Classification

• Mometasone furoate is explicitly classified as a medium-potency corticosteroid in FDA labeling 1
• Fluocinolone acetonide 0.025% is classified as a high-potency topical corticosteroid based on comparative clinical trials 3
• In head-to-head studies, mometasone 0.1% applied once daily demonstrated significantly greater efficacy than fluocinolone acetonide 0.025% applied three times daily in psoriasis patients (p < 0.01), but this reflects dosing frequency rather than inherent potency 3

Critical Age-Related Safety Concerns for 5-Year-Olds

Mometasone Safety Profile in Young Children

• FDA labeling explicitly states that safety and efficacy have NOT been established in children below 12 years of age for topical mometasone lotion, and its use is not recommended in this age group 1
• In children aged 6-23 months, mometasone caused HPA axis suppression in approximately 29% when applied over mean body surface area of 40% for approximately 3 weeks 1
• Pediatric patients have a higher ratio of skin surface area to body mass, placing them at greater risk of HPA axis suppression and Cushing's syndrome than adults 1
• Should not be used in diaper area if diapers or plastic pants are worn, as these constitute occlusive dressing 1

General Pediatric Corticosteroid Risks

• Children are at greater risk of glucocorticosteroid insufficiency during and after withdrawal of treatment 1
• Pediatric patients are more susceptible to skin atrophy, including striae, compared to adults 1
• Children applying topical corticosteroids to >20% of body surface area are at higher risk of HPA axis suppression 1
• Reported complications include linear growth retardation, delayed weight gain, and intracranial hypertension 1

Clinical Recommendation for a 5-Year-Old

Neither medication should be used as first-line therapy in a 5-year-old without careful consideration of the specific dermatologic condition and body surface area involved. The FDA has not approved topical mometasone for children under 12 years, and fluocinolone's higher potency increases systemic absorption risks in this age group 1.

If Topical Corticosteroid is Necessary:

• Limit application to smallest effective area to minimize systemic absorption 1
• Avoid application to >20% body surface area to reduce HPA axis suppression risk 1
• Use shortest duration possible and discontinue when control is achieved 1
• Avoid occlusive dressings including diapers and plastic pants over treated areas 1
• Monitor for signs of HPA axis suppression: low plasma cortisol, absence of ACTH response 1
• Watch for intracranial hypertension signs: bulging fontanelles, headaches, bilateral papilledema 1

Safer Alternatives for Pediatric Use:

• For childhood lichen sclerosus, potent topical corticosteroids (not ultrapotent) have shown effectiveness with acceptable safety profiles 4
• For infantile hemangiomas, topical mometasone furoate has been studied in superficial lesions <5 cm with 86.5% response rate, though intralesional triamcinolone showed slightly better results 4
• Medium-potency steroids with documented pediatric safety data should be considered before escalating to high-potency agents 4

Key Clinical Pitfall

The most common error is assuming that because a medication is available, it is appropriate for all age groups. The absence of FDA approval for mometasone in children under 12 years reflects insufficient safety data, not just regulatory oversight 1. Using fluocinolone (higher potency) in this age group compounds the risk of systemic absorption and adverse effects 1.