A common mistake is to be too cautious about topical steroids. Some parents undertreat their children's eczema because of an unfounded fear of topical steroids. They may not apply the steroid as often as prescribed, or at the strength needed to clear the flare-up. This may actually lead to using more steroid in the long term, as the inflamed skin may never completely clear. So, you may end up applying a topical steroid on and off (perhaps every few days) for quite some time. The child may be distressed or uncomfortable for this period if the inflammation does not clear properly. A flare-up is more likely to clear fully if topical steroids are used correctly.
Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus . Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.
As a result of this, expert panels are reluctant to endorse topical steroids being sold over-the-counter. They fear that parents wouldn't understand the risks when buying the drugs to use at home. While in most cases the effects of topical steroids on the HPA axis means only the child is at minimal risk, if they undergo a stressful physiologic (rather than psychologic) event such as trauma, surgery, or serious infection, they might have life-threatening complications. The effects on the HPA axis are reversible and usually return to normal within weeks.