TCS practicalities — source conflicts

Conflict: [DermNet, reviewed 2023] says a 4-year-old needs about 1/3 of the adult amount (adult face/neck 2.5 FTU, which implies about 0.8 FTU). [Patient.info, 2023] gives 1.5 FTU for face/neck at age 3–5. Unresolved — add to open_questions.

Conflict: [FDA OTC Monograph M017, 2023] requires OTC hydrocortisone labels to say “do not use for the treatment of diaper rash”, and [NHS, n.d.] OTC advice says do not use on the face/genitals without advice. [NICE CG57, 2007/2023] and [AFP Ference & Last, 2009] recommend mild/low-potency steroid for the child’s face, neck and nappy area. Unresolved — add to open_questions.

Conflict: [Eumovate Rx PIL, emc 3807, n.d.] says moderate TCS courses in children under 12 should not normally exceed 7 days. [NICE CG57, 2007/2023] reassesses only if not controlled within 7–14 days and continues about 48 h after symptoms subside. Unresolved — add to open_questions.

Conflict: [Eumovate Rx PIL, emc 3807, n.d.] warns prolonged daily TCS in children “can affect their growth”. [Axon et al., BMJ Open 2021] found no evidence of growth suppression; [Mooney et al., 2015] found pathological HPA suppression only with misuse. Unresolved — add to open_questions.

Conflict: [Mooney et al., Australasian consensus, 2015] says irreversible skin thinning does not occur when paediatric TCS is stopped on resolution. [AFP Ference & Last, 2009] lists “permanent dermal atrophy”; [NICE CG57/TA82] cites “irreversible skin atrophy” as a reason to switch to TCIs. Unresolved — add to open_questions.