Many patients who have chronic skin conditions, including children with eczema, use “alternative” herbal creams in place of or as adjuncts to conventional medical therapy. One reason for this is a public perception that herbal products are safer and free of steroids. Keane and colleagues were prompted to study Chinese herbal skin creams after many of the patients who visited their dermatology clinic experienced exacerbation of symptoms or complained about the cost of the alternative therapies.
The authors obtained samples of 11 Chinese herbal creams that were recommended for the treatment of eczema, scaling of the scalp and eczema herpeticum. The creams were being used by patients ranging from four months to 36 years of age. The herbal creams were analyzed for the presence of steroids. Dexamethasone was present in eight of the creams in concentrations ranging from 64 to 1,500 μg per g, with a mean of 456 μg per g. Children were being treated with creams in which the levels of dexamethasone were 5.2 times higher than those recommended for adults. The highest concentration of steroid was found in a cream that had been given to a four-month-old infant. Patients had not been advised on how to use the alternative creams and all had applied them to the face and flexures, often several times per day. Most patients reported improvement in the skin condition after using the creams, but two patients reported exacerbation of symptoms and two patients noted no improvement.
The authors raise the concern that use of Chinese herbal skin creams containing steroids could be widespread in patients with long-term skin conditions. These alternative therapies could have adverse effects and long-term consequences. In this study, the creams were applied too frequently and were used on inappropriate areas of the body. The authors are particularly concerned about their use in children and the widespread perception that these creams are safe and effective. They call for greater regulation of these medications.