999 abuse: do mothers know what they are using?

Area of Science:

• Pediatric Dermatology
• Pharmacovigilance
• Public Health

Background:

• Parents often use topical treatments for pediatric dermatological conditions without understanding their ingredients.
• Unregulated or misidentified topical creams pose significant risks when applied to children's skin.

Observation:

• An infant treated with '999' cream containing dexamethasone acetate developed severe necrotizing fasciitis, requiring extensive medical intervention.
• An 11-year-old girl using '999' cream as an emollient exhibited Cushingoid features, including accelerated BMI and weight gain with stunted height.
• Other cases involved children with eczema and impetigo treated with '999' cream, where parents were unaware of its potent corticosteroid content.

Findings:

• Unidentified topical creams, such as '999' cream, can contain potent corticosteroids like dexamethasone acetate.
• Misuse of potent topical corticosteroids in children can lead to serious adverse effects, including infections and endocrine disruption.
• Lack of ingredient awareness among caregivers contributes to the unsafe use of topical medications.

Implications:

• Healthcare providers must educate parents about the risks associated with potent topical corticosteroids and unverified treatments.
• Public health campaigns are needed to warn against the use of unknown topical medications on children.
• Physicians should consider the possibility of inadvertent potent corticosteroid use, even in parents who express aversion to steroids.