Fluticasone propionateMidchildhood acne: 2 case reports Two patients, one girl and one boy, aged 3 -5 years developed midchildhood acne following treatment with fluticasone propionate administered by face masks for asthma. Patient 1, a 3-year-old girl, presented with midfacial comedonal acne, which had persisted for 8 months.Examination revealed several open comedones with a few closed comedones affecting the midface including the cutaneous lips, lower nose and medial cheeks; scarce red papules and macules were also observed. She had a history of asthma, and was receiving fluticasone propionate 110 µg/puff, two puffs twice daily through a metered dose inhaler with spacer and face mask for 9 months. Her mother had a history of severe cystic acne. The mask was changed to a mouthpiece 2 months prior to presentation. Adapalene cream was administered with initial exacerbation of acne, and was replaced with adapalene gel with some regression. At followup, after 6 months, only a few open comedones on her nose and checks were observed with 3 to 4 red papules on the chin. Adapalene was continued.Patient 2, a 5-year-old boy, presented with inflammatory and comedonal acne primarily on his chin. Lesion onset coincided with the administration of fluticasone propionate inhaler with a face mask [dosage not stated]. Examination revealed several open comedones with a couple of red papules on his chin and lower cutaneous lip; his midforehead and glabella were severely affected with comedones. He was recently diagnosed with asthma. He had received fluticasone propionate 1 year prior with a spacer and mask for 4 months, and had experienced no skin problems. He was administered fluticasone propionate inhaler with a spacer and mask for 3 months due to wheezing exacerbation, and within 1 month of re-initiating fluticasone propionate with mask, comedonal and inflammatory acne ensued. His father and sister had a history of acne vulgaris. Adapalene and benzoyl peroxide were initiated, yet this treatment resulted in irritation, and was stopped. Fluticasone propionate was replaced with albuterol and beclomethasone dipropionate inhaler with a mouth spacer. A significant regression of acne was noted.Author comment: "In these two patients, the location and temporal relationship of the comedonal and inflammatory acne to the use of fluticasone with a mask would suggest steroid-related midchildhood acne." Liu KJ, et al. Midchildhood acne associated with inhaled corticosteroids: Report of two cases and review of the literature. Pediatric Dermatology