Topical medications and therapies are necessary for the proper management of skin diseases in children; however, physicians must be aware of the differences in percutaneous absorption and the risks for toxicity from topical medications, which are often unique to infants and children. Topical therapy must be individualized, and success often depends on proper vehicle selection, ease of application, and cost to patients and their families. Although many commercially available topical therapies are not FDA approved for use in children, recently enacted legislation has served to stimulate much-needed drug research in pediatric patients. New therapies on the horizon, such as tacrolimus, may prove to be equally efficacious and less toxic.