Which patient group is more susceptible to systemic side effects from topical corticosteroids?

• A. Older adults
• B. Infants and young children
• C. Teenagers
• D. Middle-aged adults

Answer: (B)

Topical corticosteroids can enter the bloodstream, and how much reaches systemic circulation depends on skin maturity and body size. Infants and young children are most at risk because their skin is thinner with higher permeability, and they have a larger skin surface area relative to their body weight. This means more drug can be absorbed per kilogram of body weight. Additionally, their metabolic and hormonal systems are still developing, so clearance can be slower and the hypothalamic-pituitary-adrenal axis more easily suppressed, increasing the risk of systemic effects such as growth impact and adrenal suppression. For this reason, pediatric patients—especially infants and young children—are more susceptible to systemic side effects from topical corticosteroids than older children or adults. When treating them, use the lowest effective potency for the shortest duration and monitor for systemic effects.