The authors conclude that even topical steroids at the lowest potency can induce rosacea. Low-strength steroids were implicated in more than one half of the patients in their series. The authors believe the findings support the abrupt withdrawal of steroids as one component of treatment rather than switching the patient to a lower steroid dosage, which is often the practice. They recommend the use of oral erythromycin as the treatment of choice in children with steroid-induced rosacea. They also recommend that topical steroids, including class 7 agents, be especially avoided in children who are susceptible to steroid-induced rosacea.
Why are different strengths critical? The appropriate strength depends on many factors. For example, babies absorb topical steroids faster than adults, so they may require a low-potency steroid. Areas of the body where skin touches skin (think: armpits, rectal area, etc), as well as sensitive areas (like the skin on the eyelids), tend to absorb topical steroids more rapidly, so those regions of the body also usually require a low-potency steroid. However, thick, rough skin on the palms of the hands and the soles of the feet usually absorb topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid. Keep in mind: The greater the potency of the steroid (in other words, the lower its class number), the more likely it is to cause side effects .