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Calls for re-education on the use of steroid creams for children with eczema

Photo: 'Steroid phobia' worsening child eczema
Editors Comment:

This article expresses the view of the President of the Australian College of Dermatologists, and has raised some contention and concern among our readers. Readers considering the use of steroid creams should consult their GP or specialist to ensure their individual circumstances are appropriately considered, and that current medical knowledge and best practice forms the basis of your treatment.


Original article

Australian dermatologists say there needs to be a re-education about the use of steroid creams to treat children with eczema.


Australian children are unnecessarily suffering from prolonged flare-ups of eczema because of "unfounded" concerns about steroid creams, say dermatologists.
Topical corticosteroids (TSC) remain the mainstay treatment for the chronic inflammatory disease of the skin that affects about 30 per cent of Australian and New Zealand children.

However fears and "misinformation" about their possible side effects is "undermining" the advice given by dermatologists to parents with eczema.

Long-term use of topical corticosteroids can lead to skin thinning but if used correctly this can be avoided, says the Australian College of Dermatologists.

'Steroid phobia' needs to stop, says Professor Chris Baker, president of the ACD.

A position statement on the use of corticosteroids, released by the college on Monday, calls for the re-education of health professionals and the community on the "excellent safety record" of these topical medical creams.

"Unfounded concerns about their adverse effects has resulted in 'steroid phobia' and an underutilisation of TSC, leading to unnecessary exacerbations of eczema for children," the statement says.

The recommendation to 'use sparingly' is "nonsensical" and has no value.

"There is no requirement to use sparingly. It is recommended that an ample volume of cream is applied to sufficiently cover the entire affected area," the statement adds.

It's estimated severe eczema costs over $6000 per child per year in direct medical costs, hospital and treatment costs, as well as time off work for caregivers and untold distress for the family unit.

Then there is the unseen impacts on a child.

"Although eczema in itself is not a life-threatening disease, it can certainly have a debilitating effect on a sufferer," said Cheryl Talent, President of the Eczema Association of Australasia.

"Night-time itching can cause sleepless nights and eczema 'flare-ups' can often lead to absenteeism from school. Using moisturiser to prevent the skin from cracking or itching can offer relief, but the most effective treatment for eczema is topical steroids," she said.

"Of course, it is important to seek professional medical advice before using any medication," Ms Talent added.

KEY ADVICE FROM DERMATOLOGISTS

  • Apply 1-2 times a day as per the product directions
  • Do not use sparingly. Ensure ample volume of cream is applied to sufficiently cover affected area.
  • Diluting a strong steroid cream with moisturiser does not reduce its clinical effect.
  • There is little difference in clinical effect between 0.5, 1 and 2% hydrocortisone.

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