Pablo Férnandez-Peñas, one of the authors of the article, comments:
Thank you for your letter. The use of topical corticosteroids may induce atrophy and other adverse effects. If we consider that kids have a thinner skin, with higher absorption, the use of topical corticosteroids in this population should be more cautious. However, we are not saying that topical corticosteroids should be avoided. As we say in the article, ‘Topical corticosteroids are safe and effective drugs. Always establish a clinical diagnosis before prescribing an appropriate topical corticosteroid according to the affected area, patient’s age, clinical presentation and predicted responsiveness to treatment’.
One big problem with the ‘perceived’ effect of topical corticosteroids is adherence to treatment. Patients (and relatives) tend to largely exaggerate their use of topical products. This gives some doctors a false sense of security, and it is probably behind the concept of ‘tachyphylaxis’. This is when patients say they are using the topical product when they are not, and suggests the disease is ‘resistant’ to treatment.
Controlled studies have found that atrophy changes appear after seven days of use with moderate potency topical corticosteroids. We should always keep the risk of atrophy and patients’ compliance in mind when prescribing topical corticosteroids, and always give clear guidelines including appropriate treatment duration.
