![]() Application of topical steroids over >20% of BSA in pediatric patients increases risk of HPA axis suppression. Due to a higher BSA to weight ratio, pediatric patients are at a greater risk of HPA axis suppression and Cushing syndrome compared to adults. Follow-up testing 2 to 4 weeks after discontinuation of therapy demonstrated suppressed HPA axis function in 1 of 5 patients who used the cream, 3 of 8 patients who used the ointment, and 1 of 8 patients who used the lotion/solution. Of the patients with normal baseline adrenal function, adrenal suppression occurred in 16% of patients using the cream, 27% of patients using the ointment, and 29% of patients using the lotion/solution. Open-label safety studies conducted in infants and children 6 to 23 months of age with atopic dermatitis demonstrated a high incidence of adrenal suppression when topical mometasone furoate products were applied once daily for approximately 3 weeks over a mean BSA of ~40%. Infants and small children may be more susceptible to HPA axis suppression, intracranial hypertension, Cushing syndrome, or other systemic toxicities due to larger skin surface area to body mass ratio. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. The extent of percutaneous absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Warnings: Additional Pediatric Considerations
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