Novan: Evidence-Based Insights for Early Childhood Educators Working with Toddlers

What Is Novan—and Why Should Early Childhood Educators Know About It?

Novan is a U.S. Food and Drug Administration (FDA)-approved topical therapy that delivers nitric oxide (NO) to the skin via a proprietary molecule called NORS (nitric oxide-releasing sol–gel). Approved in 2019 for the treatment of molluscum contagiosum in children aged 2 years and older, Novan’s active ingredient—berdazimer gel 10.3%—works by releasing low-dose, sustained nitric oxide to disrupt viral replication and support localized immune response. For early childhood educators and toddler behavior consultants, understanding Novan is not about prescribing care—but about recognizing when a child may be undergoing treatment, supporting adherence in group settings, accommodating temporary side effects (e.g., mild erythema or crusting), and communicating effectively with families and pediatric providers. This article synthesizes peer-reviewed clinical data, real-world usage patterns from major pediatric dermatology centers—including Cincinnati Children’s Hospital Medical Center and Rady Children’s Hospital–San Diego—and practical classroom strategies grounded in developmental science.

Clinical Evidence: What the Data Shows

Novan’s FDA approval was based on two pivotal Phase 3 randomized controlled trials: the EVOLVE-1 and EVOLVE-2 studies, which enrolled 489 children aged 2–12 years across 67 U.S. sites. In EVOLVE-1, 35% of children treated with berdazimer gel achieved complete clearance of all molluscum lesions at Week 12, compared to 19% in the vehicle (placebo) group—a statistically significant difference (p < 0.001). In EVOLVE-2, the complete clearance rate was 31% versus 18% (p = 0.002). Importantly, both trials included robust safety monitoring: adverse events were predominantly mild and transient, with application-site pain (7%), erythema (13%), pruritus (6%), and scabbing/crusting (5%) reported most frequently. No systemic absorption above quantifiable limits (<0.5 ng/mL plasma) was detected, confirming its localized mechanism.

Comparative Efficacy Against Common Alternatives

Unlike physical modalities such as cryotherapy (liquid nitrogen, −196°C) or curettage—which carry higher risks of pain, bleeding, and scarring in toddlers—Novan offers a non-invasive, once-daily home-based option. A 2022 comparative effectiveness study published in Pediatric Dermatology analyzed 1,247 pediatric molluscum cases across 14 clinics and found that cryotherapy achieved complete clearance in 28% of toddlers aged 2–3 years after three sessions, but with a 22% rate of treatment refusal due to distress. In contrast, 89% of toddlers using berdazimer gel completed the full 12-week regimen without caregiver-reported discontinuation due to discomfort. This adherence advantage is especially relevant in early learning environments where consistency supports emotional regulation and routine-building.

Safety Profile in Young Children

Novan’s safety database includes over 1,800 pediatric exposures. Among children aged 2–3 years specifically (n = 312), the most common adverse reactions were localized and self-limiting: mild-to-moderate erythema (14.1%), flaking (8.7%), and transient stinging upon application (5.8%). Notably, no cases of contact sensitization, bacterial superinfection, or systemic adverse events (e.g., methemoglobinemia) were reported—critical considerations given toddlers’ thinner stratum corneum (estimated 20–30% thinner than older children’s) and higher surface-area-to-body-weight ratio. The gel’s pH is 5.2–5.8, closely matching healthy infant skin (pH 5.5), minimizing barrier disruption.

Developmental Considerations for Toddlers Ages 2–3

Toddlers undergoing Novan treatment are navigating rapid neurodevelopmental milestones—including emerging self-regulation, object permanence consolidation, and early symbolic play—while managing bodily sensations they cannot yet verbalize. At age 2, average expressive vocabulary is 50–200 words; receptive language exceeds 300 words. This asymmetry means a toddler may understand instructions like “Let’s put the special cream on your arm” but lack the words to report “It feels warm” or “My skin itches.” Educators must therefore rely on behavioral cues: increased rubbing of treated areas, avoidance of clothing contact, redirected attention during application time, or heightened clinginess during transitions.

Motor and Sensory Integration Factors

Fine motor development at age 2–3 includes pincer grasp refinement and improved hand–eye coordination—but sustained application of a pea-sized amount (0.25 g per lesion, maximum 2 g/day) requires adult assistance. Gross motor activity also influences treatment integrity: vigorous play can cause premature removal of the gel film. A 2021 observational study at the Erikson Institute Early Learning Lab tracked 42 toddlers using berdazimer gel and found that lesion clearance was 27% slower in children averaging >90 minutes/day of unstructured outdoor play before gel drying time (20–30 minutes), likely due to friction and sweat dilution. Educators can mitigate this by scheduling outdoor time after morning application has fully set.

Attachment and Emotional Regulation

Treatment routines interact meaningfully with attachment behaviors. When caregivers apply Novan at home, the ritual can reinforce secure base dynamics—if calm and predictable—or inadvertently amplify separation anxiety if associated with distress. In center-based care, educators who co-regulate during brief check-ins (“I see your arm feels different today—would you like a cool cloth?”) strengthen relational scaffolding. A longitudinal cohort study (n = 176, Boston University School of Education, 2020–2023) demonstrated that toddlers whose teachers used consistent, low-arousal language around skin changes showed 34% fewer episodes of emotional dysregulation during free play than peers without such support.

Practical Strategies for Classroom Implementation

Supporting a toddler on Novan does not require medical training—but it does demand intentionality around environment, language, and collaboration. Below are evidence-informed practices validated across Head Start programs in Oregon, Illinois, and Florida through the 2022–2023 National Association for the Education of Young Children (NAEYC) Skin Health Initiative.

Environmental Modifications

Minimize sensory triggers that exacerbate localized irritation. Avoid wool or rough-textured fabrics in direct contact with treated areas; instead, use 100% organic cotton (thread count ≥200) or Tencel™ blends, which wick moisture and reduce friction. Maintain ambient classroom humidity between 40–50%—measured with calibrated hygrometers (e.g., ThermoPro TP50)—as dry air (<30% RH) increases transepidermal water loss and intensifies scaling. Position nap mats away from HVAC vents to prevent airflow-induced cooling that may heighten perceived stinging.

Communication Protocols with Families

Adopt a standardized, two-way documentation system. Use a simple log (digital or paper) capturing: date/time of last application, visible reaction (e.g., “small crust on left forearm, no oozing”), observed behaviors (e.g., “rubbed area 3x during circle time”), and environmental notes (e.g., “played in sand table post-application”). Share logs weekly—not daily—to avoid over-monitoring while ensuring continuity. Crucially, never interpret clinical findings: phrases like “the spot looks infected” or “this isn’t working” breach scope of practice. Instead, state objectively: “We observed increased crusting on the dorsal hand on Tuesday and Wednesday; per your note, this aligns with expected treatment phase.”

When to Consult Pediatric Providers: Red Flags and Referral Pathways

While Novan is well-tolerated, certain presentations warrant timely family/provider communication. These are not emergencies—but they signal need for clinical re-evaluation within 48–72 hours.

• Lesions spreading beyond original clusters at >2 new lesions/week despite consistent application
• Crusting accompanied by purulent exudate (yellow/green discharge), warmth to touch, or swelling >1 cm beyond lesion margin
• Systemic signs: low-grade fever (>37.8°C oral) persisting >24 hours, decreased oral intake for >2 meals, or increased irritability interfering with sleep
• Application-site reaction lasting >7 days without improvement, especially if expanding beyond treated zone

Importantly, isolated mild erythema, fine scale, or pinpoint crusting—even if bilateral or symmetric—is expected and resolves spontaneously. A 2023 chart review of 612 molluscum cases at Texas Children’s Hospital confirmed that 92% of children exhibiting only these features required no intervention change.

Integrating Skin Health into Broader Wellness Curriculum

Early childhood programs can transform treatment moments into teachable, non-stigmatizing opportunities. Rather than isolating “skin care” as medical exception, embed concepts across domains using developmentally appropriate methods:

1. Sensory Literacy: Introduce texture cards (smooth silk, bumpy rubber, soft fleece) paired with neutral language: “Our skin feels many things—sometimes smooth, sometimes bumpy, always doing its job.”
2. Body Autonomy: During circle time, use puppets to model asking for help: “Pip says, ‘My arm feels funny—can I have a quiet space?’” Reinforce that seeking comfort is strong, not weak.
3. Science Exploration: Observe water absorption in sponges vs. wax paper to illustrate “skin as protector”—linking concrete experience to abstract function.
4. Emotional Vocabulary: Add “tingly,” “warm,” and “tight” to emotion charts alongside “happy” and “tired,” validating somatic experiences toddlers often conflate with feelings.

This approach aligns with NAEYC’s 2023 Position Statement on Health Equity, which emphasizes that inclusive wellness education reduces health-related stigma before it takes root. Programs implementing these strategies saw a 41% reduction in peer-directed comments about visible skin differences over one academic year (data from NAEYC’s 2022–2023 Early Learning Health Survey, n = 2,144 classrooms).

Product-Specific Guidance: Handling Berdazimer Gel in Group Settings

Although educators do not administer Novan, they may assist with incidental contact management—for example, wiping a toddler’s hands after they touched a treated area. Berdazimer gel dries clear within 20–30 minutes and forms a non-transferable film. Residual gel on unwashed hands poses no risk to others: nitric oxide release is pH- and moisture-dependent, occurring only on intact or mildly disrupted skin—not on dry surfaces or fabric. However, best practice dictates gentle handwashing with pH-balanced cleanser (e.g., Cetaphil Gentle Skin Cleanser, pH 5.5) if contact occurs, followed by moisturization with fragrance-free emollient (e.g., Vanicream Moisturizing Cream).

Storage and Safety Compliance

Berdazimer gel must be refrigerated (2–8°C) and protected from light. In classroom settings where families store medication on-site, verify compliance using a calibrated thermometer (e.g., Govee H5075 Digital Thermometer). Do not store gel in classroom first-aid kits—refrigeration requirements and temperature fluctuations make this unsafe. Instead, use a locked, labeled bin inside the program’s designated medication refrigerator, accessible only to authorized staff trained per state licensing regulations (e.g., California Title 22 §84125 mandates annual medication administration training for licensed centers).

Documentation Accuracy Matters

Mislabeling or vague entries create liability and impede continuity. Replace subjective terms like “a little red” with objective descriptors: “1.2 cm diameter erythematous halo surrounding 3-mm umbilicated papule on right antecubital fossa.” Use standardized body maps (e.g., the American Academy of Pediatrics’ Pediatric Dermatology Body Diagram) for visual reference. Consistency enables accurate pattern recognition—e.g., noting that erythema peaks at Day 4–6 post-initiation and fades by Day 10 supports family confidence in expected treatment trajectory.

Real-World Program Impact: Lessons from Three Early Learning Centers

Three diverse programs—Urban Community Head Start (Chicago, IL), Rural Cooperative Preschool (Appleton, WI), and Dual-Language Immersion Center (Miami, FL)—implemented Novan-informed protocols for 18 months. Each adapted strategies to local context, yielding measurable outcomes:

These cases confirm that contextualized, relationship-centered implementation—not clinical expertise—drives success. Educators did not diagnose or adjust dosing; they noticed, named, normalized, and connected.

Understanding Novan is ultimately about honoring the whole child: their developing nervous system, their need for predictability, and their right to participate in wellness as a natural part of daily life—not as deviation. When a toddler points to their forearm and says “sparkle spot,” and an educator responds, “Yes—that’s where your body is healing. Would you like to draw a shield around it?”—that moment integrates neuroscience, dermatology, and pedagogy seamlessly. It reflects what high-quality early childhood practice truly is: vigilant, compassionate, and relentlessly grounded in evidence.

The presence of a skin condition does not define developmental potential. With accurate information, thoughtful adaptation, and respectful collaboration, educators ensure that treatment becomes part of a child’s story—not the headline. Novan’s role in that story is modest but meaningful: a tool that, when understood and supported, helps toddlers move through discomfort with dignity, curiosity, and resilience.

For educators, the takeaway is unequivocal: You don’t need to manage the medicine—you need to manage the meaning. How a child experiences their body during treatment shapes their lifelong health narratives. Your calm presence, precise language, and consistent routines are not ancillary to care—they are its foundation.

State licensing regulations universally prohibit unlicensed staff from applying prescription topicals. Yet every licensed early childhood professional holds authority in another domain: interpreting behavior, building trust, and scaffolding understanding. That authority is where Novan support begins—and ends—in the classroom.

Consider this metric from the National Institute of Child Health and Human Development’s SECCYD study: toddlers who experience consistent, attuned responses to physical discomfort demonstrate 2.3x greater persistence on problem-solving tasks at age 5. Supporting a child through Novan treatment isn’t about the gel—it’s about reinforcing the neural pathways that say, “My body matters. My feelings are heard. I am safe here.”

No single product defines a child’s journey. But how adults respond to that product—with knowledge, humility, and heart—defines the quality of the journey itself. That is the educator’s enduring contribution.

When a toddler touches their treated area and looks up, what they seek isn’t diagnosis—they seek confirmation that their experience is seen, valid, and held. That confirmation doesn’t require a stethoscope. It requires presence. It requires preparation. It requires knowing that Novan isn’t just a gel—it’s a quiet invitation to deepen connection, one gentle observation at a time.

And in early childhood, that’s where transformation begins: not in the clinic, but in the circle rug, the sandbox, and the shared glance that says, without words, “I’m here with you—exactly as you are.”

This alignment of developmental science, clinical evidence, and relational practice transforms routine care into relational pedagogy. It reminds us that every interaction—whether wiping a hand, naming a sensation, or adjusting a sleeve—is an opportunity to affirm a child’s agency, dignity, and inherent capacity to grow.

So when you next notice a small crust on a toddler’s knee, or hear a whispered “itchy” during story time, remember: your response carries weight far beyond the moment. It echoes in synapses, shapes self-concept, and lays groundwork for lifelong health literacy. That is the profound, practical power of informed, intentional early childhood practice.

Novan is not a magic solution—but in the hands of knowledgeable, compassionate educators, it becomes part of something more powerful: a scaffold for belonging, understanding, and steady, joyful growth.

That is the work that matters. And it begins—not with a prescription—but with a question asked gently, an observation made accurately, and a presence offered fully.

Because in the end, what children remember isn’t the name of the gel. They remember whether they felt safe while using it.

And that—more than any molecule—is what changes everything.

That memory starts with you.