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• Herbal skin creams for atopic eczema
  Peter M Lapsley
  Published on: 23 January 2004

• Published on: 23 January 2004

  Herbal skin creams for atopic eczema

  • Peter M Lapsley, Chief Executive

  Dear Editor

  Ramsay et al. are right to draw attention to the fact that many 'herbal creams' for atopic eczema contain potent or very potent topical steroids. Their research echoes that done by Keane et al. [1] which showed that of 11 Chinese herbal treatments obtained from patients attending dermatology outpatient clinics at King's College Hospital, eight contained dexamethasone at a mean concentrati...

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  Dear Editor

  Ramsay et al. are right to draw attention to the fact that many 'herbal creams' for atopic eczema contain potent or very potent topical steroids. Their research echoes that done by Keane et al. [1] which showed that of 11 Chinese herbal treatments obtained from patients attending dermatology outpatient clinics at King's College Hospital, eight contained dexamethasone at a mean concentration of 456 µg/g.

  What is ironic about this is that patients or their parents or carers often turn to 'herbal creams' because of steroid phobia - the misplaced belief that corticosteroids are unsafe, even when used properly and under the guidance of a clinician.[2] In the absence of almost any guidance about their use, people may apply 'herbal creams' to areas of sensitive skin such as the face and flexures, and they may use them for protracted periods, possibly causing precisely the damage they were seeking to avoid.

  The problem is the more frustrating because atopic eczema can usually be more effectively treated than most people imagine. Even in severe cases, the proper use of emollients and corticosteroids can produce dramatic improvement in most cases of eczema. This was demonstrated clearly by Cork et al. in their recent audit of adverse drug reactions to aqueous cream in children with atopic eczema.[3] The availability of new topical immunomodulators for those whose eczema does not respond to topical corticosteroids - for whatever reason, including non-compliance through steroid phobia - may be expected to reduce the burden of atopic eczema still further.

  All this being so, doctors should advise their patients to be extremely cautious in experimenting with so-called 'herbal treatments' for skin diseases. As an eminent professor of dermatology said recently, "if an 'alternative' treatment for a skin disease appears to work like magic, one should be extremely wary of it."

  References

  (1) Keane F.M., Munn S.E., du Vivier A.W.P., Taylor N.F. and Higgins E.M., Analysis of Chinese herbal creams prescribed for dermatological conditions; BMJ 27 February 1999;318:563-564

  (2) Charman C.R., Morris A.D., Williams H.C., Topical corticosteroid phobia in patients with atopic eczema; British Journal of Dermatology 2000; 142: 931-936.

  (3) Cork M J et al. An audit of adverse drug reactions to aqueous cream in children with atopic eczema Pharmaceutical Journal, 2003; 747-748 (29 November.)

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  Conflict of Interest:
  None declared.

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