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US-based skin specialist sets out advantages of newer creams over prescriptions containing skin-thinning steroids

ALTHOUGH MOST eczema cases are diagnosed in early childhood, many sufferers live with it throughout their lives. There is no cure for eczema but it can be controlled.

Traditional treatments involve topical corticosteroids,  or steroid creams applied to the skin, but these can thin the skin and cause stretchmarks and discoloration.

A new non-steroid topical ointment  called Protopic  is available as an alternative.

Protopic's manufacturer, Fujisawa Pharmaceuticals (China),   recently invited American dermatologist Alan Fleischer to Hong Kong to discuss the difference between non-steroid and steroid-based treatments to an audience of  doctors.

Dr Fleischer is the professor and chair of dermatology at the School of Medicine at Wake Forest University in Winston-Salem, North Carolina.

He  said while the general belief was that  corticosteroids cleared symptoms quickly, trials had shown that even the strongest - mometasone furoate cream -  only managed to  clear eczema symptoms completely in three weeks for 94 per cent of  patients.

Trials also showed strong corticosteroids caused a 9 per cent reduction in skin thickness after four weeks' use, he said, dispelling the myth that topical corticosteroids cause no skin damage.

Even the weakest corticosteroid, hydrocortisone, caused skin thinning.

There are two non-steroid topical immunomodulators (TIM)  on the market, tacrolimus  and pimecrolimus. Protopic  contains tacrolimus.

While it was generally believed  they are equally effective, Dr Fleischer  said a  comparative study showed  more patients stopped using pimecrolimus than tacrolimus, due to  a lack of efficacy.

Even though the side effects of the two were similar,  a higher percentage of patients using tacrolimus achieved success, he  said.

The doctor noted that  some patients found tacrolimus caused  a burning sensation, but he said this was normal during the first few days and disappeared when the skin lesion cleared.

Before  non-steroidal topical  creams  were created 10 years ago, little research was conducted on the side effects of steroid creams. Physicians had little choice. Either they had to prescribe  steroids or not treat patients at all.

Dr  Fleischer said another problem with steroids was that patients were afraid to use products made with them because of their adverse effects.

'They will either not use it or stop treatment early,' he  said. 'With Protopic, patients are not afraid of the drug and will continue to use it. Therefore ... the result will be better.'



Alternative to traditional treatment means none of its side effects