Topical Steroid Use and Fracture Risk in Children With AD

child boy hand eczema dermatitis
A little redhead boy is showing the sunburn he has on his hands. His hands are very red and dry.
A link between topical corticosteroid use and fracture risk in children is assessed.

In children with atopic dermatitis (AD), the use of topical corticosteroids is not associated with a significantly increased risk for fracture, according research findings published in the Journal of the American Academy of Dermatology.

The study was an analysis of medical record data in the centralized Rochester Epidemiology Project (REP) that focused on children who had been diagnosed with AD before 4 years of age from 2004 to 2017. Resources of the REP were used to identify prescriptions for topical corticosteroids, while bone fractures were identified based on diagnosis codes.

In total, 3542 children with AD were included in the study. The majority of patients (67.3%) were prescribed a topical corticosteroid before the age of 4 years. Among these patients, 12.7% experienced a fracture following AD diagnosis. The median age at time of fracture was 7.4 years.

When assessed as a time-dependent covariate, the use of a topical corticosteroid was associated with a 17% increase in fracture risk, but this was not statistically significant (adjusted hazard ratio [HR], 1.16; 95% CI, 0.94-1.43; P =.18).

The landmark analysis (n=2499), which was conducted as a sensitivity analysis, defined each patient’s 4th birthday as either the landmark or starting point. Similar to the primary analysis, the majority of patients in the landmark analysis (68.9%) had a topical corticosteroid prescription before 4 years of age and 13.3% experienced their first fracture following their AD diagnosis (median age, 8.7 years).

In a comparison between those with vs without corticosteroid prescriptions, the researchers found no association between use of topical corticosteroids and risk for fracture (adjusted HR, 1.00; 95% CI, 0.80-1.26; P =.99).

Limitations of the study were the predominantly White population, the retrospective design, and the lack of an active comparator arm.

The researchers wrote that “future studies are required to address confounding covariates such as the presence of asthma, the number of visits for AD, systemic corticosteroid exposure, and cumulative exposure to topical corticosteroids.”


Imhof RL, Weaver AL, St Sauver J, Hand J, Davis DMR, Tollefson MM. Association between topical corticosteroid use and fracture risk among pediatric patients with atopic dermatitis. J Am Acad Dermatol. Published online Aug 21, 2021. doi:10.1016/j.jaad.2021.08.030