Eczema, also known as dermatitis, is a common dry and itchy skin condition that affects an estimated one in five children, writes Consultant Dermatologist, Dr Adzura Azam.
While most children grow out of it, roughly 5-10 per cent of cases continue into adulthood, with some patients even first developing it in adulthood.
There are many factors affecting eczema and treatment is geared towards a holistic approach. The two common strategies are preventing/limiting the trigger factors where applicable, such as house dust mites, fur, and cows’ milk (where intolerance is established ) and active treatment involving creams and sometimes tablets.
One of the active treatments used is steroid creams. They have an anti-inflammatory effect and if used appropriately can provide significant relief to eczema sufferers.
Unfortunately the risks of topical steroids have been misunderstood or exaggerated over the years, leading to widespread ‘steroid phobia’ amongst not only the general public, but also – based on my own observation and from studies - among health professionals such as GPs and Pharmacists.
It is also not limited to the UK; there are many other countries documenting the presence of steroid phobia including USA and Japan.
Most people will immediately think of skin thinning when steroids are mentioned. This fear not uncommonly translates into patients under-treating their eczema. For parents, this means under-treating their child. Potent and very potent topical steroids can potentially cause skin thinning but with correct use, this can easily be avoided.
Early changes are also reversible. In fact, if one looks at the patches of eczema, they are commonly rough and thicker than normal skin and could benefit from the thinning effect.
However, with steroid fear being prevalent among a wide range of health professionals, patients can sometimes be given conflicting advice. Information leaflet found in the boxes of those creams can also be confusing at times.
There is also the common mistake of confusing anabolic steroids with topical steroids. Anabolic steroids, which have received bad publicity over the years due to abuse by athletes, come in tablet form; they are absorbed into the body and can affect growth. Topical steroids are applied to the skin and has mainly local effects, hence growth is not affected.
In patients with darker skin type, there is a misconception that topical steroids will make the skin darker. In fact, using them sooner in active eczema actually helps to reduce the colour changes.
Topical steroids have been tried and tested for the last 60 years and whilst new treatments with steroid-sparing agents have been introduced, topical steroids are still the mainstay of treatment due to their safety and effectiveness.