Standard disclosure on package insert of prescription topical steroids:

“Like all steroids, fluocinonide may slow down the growth rate of children and teenagers. Contact your child’s healthcare provider if you are concerned about a slow growth rate in your child. In general, children may be more susceptible to side effects of steroids. Close monitoring is necessary for any child receiving long-term steroids in any form.

For the higher strength of fluocinonide (Vanos), it is not recommended to use the product for more than two weeks at a time. Although the drug is highly effective, it should not be used on a long-term basis.

Question 1: How do steroids affect my child’s growth potential?

Answer 1: They slow down the endocrine system which is responsible for creating its own growth hormones. There is also more mineral depletion and that directly affects bone density and growth. In adults and elderly that is considered osteoporosis, but for children, it is a serious consideration and should always be monitored closely by your doctor and yourself.

Question 2: How can I offset the effect of topical steroids on my child who needs this medication?

Answer 2: Follow the manufacturer’s recommendation of STOPPING every 2 weeks. The body needs rest periods to allow the skin, adrenals, and the rest of the endocrine system to jumpstart itself back up to continue doing its work.  You have to shock and pause every few weeks. Please get a second and third opinion if a doctor tells you to keep using topical steroids “continuously as needed” or to use more without a full strategy in place.

KEEP A DIARY of when and how often you are applying the steroids.  Note how extensively you are applying based on time of day or night and on how much body surface and the quantity used. That will really make a difference.  If you use more than 2 gms. at 2% strength of topical steroids on 20% of the body (arms) for 2 weeks, you are already risking adrenal suppression. That’s all it takes.

In some cases, where the skin is already thin (face, trunk, genitals) it may take less to absorb more. If the skin is open, sores and with lesions, then most likely, your child will be absorbing far greater than the doctor’s recommended dosage based on standard situations.

Question 3: If my child has asthma and takes a steroid inhaler, does that double up his intake, and should I be worried?

Answer 3: Being able to breathe normally is non-negotiable and top priority. However, there are now new inhalers that have very minimal or no steroids becoming more available. Express your concerns with your child’s pediatrician. Ask for more information on how to balance the cumulative effects of both. Again that diary will become immeasurably valuable when you discuss a precise health strategy with a caring team of medical practitioners.