From the Guidelines
A child can start using topical steroids after finishing a 5-day course of oral steroids, but the decision should be made in consultation with the child's healthcare provider, considering factors such as the child's age, affected body area, and disease severity, as outlined in the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1. When transitioning from oral to topical steroids, it's crucial to select the appropriate potency of topical steroid, as they vary from mild to very potent, and to apply them as directed by the healthcare provider. The guidelines suggest considering several factors, including sites of involvement, type and thickness of psoriasis, age of the patient, total body surface area (BSA) of application, anticipated occlusion, and disease acuity, among other patient-, disease-, and drug-related factors 1. Some key points to consider when using topical steroids include:
- Topical corticosteroids are available in a wide variety of delivery vehicles and are used in all phases of the disease, from gaining control during flares to maintenance 1.
- A popular routine is dual topical therapy with a high- or ultra-high-potency topical steroid and topical vitamin D analogue, although the efficacy of compounded versus separate, simultaneous treatments is not well studied 1.
- The application frequency and duration should be guided by the healthcare provider, taking into account the potential for systemic absorption and side effects with prolonged use of potent topical steroids, especially on large body areas or under occlusion 1.
From the Research
Topical Steroids After Oral Steroids
- There is no direct evidence to suggest that a child cannot start using topical steroids after finishing a 5-day course of oral steroids 2, 3.
- However, it is essential to consider the potential risks and benefits of using topical steroids, especially in children, as they can cause adverse effects such as atrophy, striae, and rosacea 2.
- When prescribing topical corticosteroids for children, lower potencies and shorter durations should be used to minimize the risk of adverse effects 2.
- The decision to start topical steroids after oral steroids should be made on a case-by-case basis, taking into account the individual child's condition and medical history 3, 4.
- It is crucial to educate patients and caregivers on the correct application and use of topical corticosteroids to ensure safe and effective treatment 2.
Considerations for Topical Steroid Use
- Topical corticosteroids can be used safely and effectively in patients who are pregnant or lactating 2.
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 2.
- Patients may be taught application using the fingertip unit method to ensure correct dosage 2.
- Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 2.
General Steroid Use
- Steroids have been used for many years to treat various disease states, and their use requires careful consideration of the potential risks and benefits 3, 4.
- Clinically relevant side effects of steroids are common and problematic, and practitioners must be aware of these potential risks 3, 4.
- The use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning, but there are multiple potential adverse effects, including toxicity to articular cartilage and numerous systemic side effects 4.