Topical Steroids for 5 Year Old?

Q: My son is 5 years old and has been on a variety of eczema treatments, such as Elidel and Derma-Smoothe. What are the recommendations for Derma-Smoothe? His skin improved initially after using this for four weeks, then he went right back to breaking out. I also have tried over-the-counter hydrocortisone (1 percent) and hydrocortisone oil (.5 percent). Any other suggestions?

A: Derma-Smoothe/FS topical oil consists of a fluorinated steroid, fluocinolone acetonide, in a blend of oils that includes refined peanut oil. It is biologically stronger than hydrocortisone despite its 0.01 percent concentration compared to hydrocortisone’s 1 percent.

Often topical steroids seem to work better at first rather than over the long term. This phenomenon, called tachyphylaxis, is partly due to the body’s ability to increase its metabolism of some drugs when used regularly (think narcotics and alcohol). This has led some dermatologists to advocate “pulse” treatments, where more potent topical steroids are used, for example, only on weekends.

Topical steroids and other topical medications constitute only part of the treatment regimen. Follow your doctor’s advice, but don’t minimize the need to do the other things, such as using moisturizers regularly and avoiding irritants and other “flare factors.”