What are the common side effects of topical corticosteroids in children, and how can I mitigate them?

Common side effects of topical corticosteroids in children include irreversible skin atrophy and striae, particularly with continuous use of potent or very potent corticosteroids. Systemic side effects may also occur if applied continuously over extensive areas of the body. These side effects can lead to unstable psoriasis and other adverse effects such as steroid atrophy. Children are especially vulnerable, and very potent corticosteroids should not be used in this group. Regular review is recommended to monitor for these adverse effects.

Strategies to mitigate these side effects include:

• Using the lowest potency corticosteroid appropriate for the child's age and the area being treated.
• Limiting the duration of treatment with potent corticosteroids to no longer than 14 days in children aged 12 months or over, and avoiding use on the face or neck.
• Avoiding very potent corticosteroids in children and young people altogether.
• Allowing breaks of at least 4 weeks between courses of potent corticosteroids to reduce risk of skin atrophy.
• Considering non-steroidal topical treatments such as vitamin D analogues or topical calcineurin inhibitors as alternatives or adjuncts, especially when there is a risk of steroid side effects.
• Providing clear instructions on safe application and ensuring adherence to prescribed regimens.
• Offering regular reviews, at least annually, to assess for steroid atrophy and other adverse effects.
• Referring to specialist dermatological advice if eczema or psoriasis is uncontrolled despite appropriate corticosteroid use.

These measures help balance effective disease control with minimising harm from corticosteroid use in children.

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