The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – I enjoyed the article ‘Rational use of topical corticosteroids’ (Aust Prescr 2013;36:158-61). I did, however, find the sentence ‘Topical treatment in children should be used with extreme caution’ surprising. In general, topical corticosteroid treatment in children is remarkably safe – so safe that some products are available without any prescription. Possibly the authors were referring to more potent corticosteroids such as mometasone or methylprednisolone. Even then, ‘extreme’ caution is unnecessary given their excellent safety record, even when substantially misused. The article was otherwise excellent and appreciated.

Rod Phillips
Paediatric skin specialist
Royal Children’s Hospital
Melbourne

Author's comments

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.