Skin thinning: No significant differences in 2 RCTs of 2–4 weeks compared with emollient/vehicle: (1) 0/196 children with very potent TCS and 0/33 vehicle, (2) 6/109 very potent TCS vs 2/50 vehicle, p=0.69. Very low rates.

Other cutaneous adverse events: No significant differences in 5 RCTs (2–4 weeks) between TCS (various potencies) and emollient/vehicle (n=172, plus one study, n not specified). Low event rates.

Biochemical evidence of adrenal suppression: Meta-analysis (11 observational studies, max 4 weeks)—20/522 children with any potency TCS (3.8%, 95% CI 2.4% to 5.8%), 3/148 children (2%) with mild potency TCS. Effects were transient.

Clinical symptoms or signs of adrenal suppression: none observed in same as above observational studies.

Skin thinning: Higher with TCS than TCI (meta-analysis of 4 RCTs: RR 4.86, 95% 1.06 to 22.28, n=4128) but very low rate (8/2068, 7 of which were using potent TCS).

Other cutaneous adverse events: No difference in skin infections between TCS and TCI (8 RCTs). Skin burning and pruritus lower with TCS than TCI: meta-analysis of 10 RCTs: burning—RR 0.31, 95% CI 0.23 to 0.40 (n=4211), pruritus—RR 0.68, 95% CI 0.56 to 0.82(n=4211).

Growth rate: no differences in growth rates tween TCS and TCI (1 RCT of 2418 children with 5 years follow-up).

Lymphoma: no cases reported in one same large RCT as above. One cohort study (n=1 438 333, approx. 4 years follow-up)—very small non-significant increase with TCI and TCS compared with general population. One case–control study—no increased risk with TCS or TCIs (294 cases/293 000 controls).

Skin thinning: no cases using once daily vs twice daily potent TCS for 3 weeks (1 RCT, 94 adults).

Other cutaneous adverse events: no significant difference between groups in telangiectasia, folliculitis, or burning/itching/stinging (4 RCTs, 4–16 weeks follow-up 740 older children/adults).

Biochemical evidence of adrenal suppression: no significant differences between once and twice daily moderate/potent TCS up to 2 weeks in children (2 RCTs, n=129).

Skin thinning: no cases with 16–20 weeks of 2 days/week of potent TCS vs vehicle (5 RCTs, n=993).

Other cutaneous adverse events: no significant differences between groups, including folliculitis and transient telangiectasia, with potent TCS (16–20 weeks) compared with either vehicle or another TCS (2 RCTs, n=423). Events were uncommon in both groups.

Biochemical evidence of adrenal suppression: no cases with 16 weeks of 2 days/week of potent TCS (2 RCTs, n=129). Possible adrenal suppression in 2/44 children with potent TCS compared with zero using vehicle (1 RCT, 20 weeks).

Skin thinning: no cases in two observational studies (potent TCS +wet wrap, 1–2 weeks, n=44).

Other cutaneous adverse events: One case of striae in two observational studies, n-44. More folliculitis with diluted potent TCS (10/19 children) compared with emollient (2/20), both under wet wrap (1 RCT). A meta-analysis (2 RCTs, n=69) of wet wrap vs no wet wrap (mild potency)—no significant difference in cutaneous adverse events.

Biochemical evidence of adrenal suppression: reported in three observational studies (2–14 days of diluted potent TCS under wet-wraps in 74 children) but rates not specified in review. Described as transient in two studies.

Growth or bone turnover: no effect seen in one small short-term observational study (potent TCS wet-wrap in eight children, (median follow-up 12 weeks).