Are there specific concerns about using steroids in children?
Children are smaller than grownups, so they have a different body surface area to weight ratio. If you put a steroidal cream or ointment or gel on a child, they’ll have relatively more absorption than somebody who’s bigger. So the concerns that we have with grownups for steroids are the same but even more in children. We worry about growth issues and adrenal suppression. We worry about cataracts and glaucoma, thinning of the skin, stretch marks, broken blood vessels. We also worry that the skin becomes used to having the steroid there, so that when it’s gone you can have a worsening of the skin rash and the skin can become very uncomfortable, and then you have to wean them off. I’m very concerned about side effects of steroids, and I find that when I have somebody on a topical steroid, I have to monitor them much more closely. I do this in one of two ways. One, I have office visits more frequently, so that I can make sure that I come across very clearly on my concerns. Two, I give only
