1. My skin will become resistant to steroids, and they won’t work

Many people believe this; after using steroid cream for a couple of weeks they stop, and although it improves, within a few weeks the eczema returns. Why?

The eczema inflammation may be suppressed by the steroid component of cream, but the flare is usually due to a bacteria called Staph aureus, which releases a toxin that stimulates histamine release in the skin. The steroids suppress the histamine and inflammation, but nothing has been done about the staph, so back to square one. The flare of eczema returns.

Remedy: use a cream containing both diluted steroid and effective antibacterial to kill the staph at the same time. Then keep the staph away and use a very small amount of steroid while the skin recovers fully.

The skin barrier defect remains a problem even after steroids are stopped, and takes time to repair, so moisturisers containing ceramides and natural healing compounds are needed for several months. Flares are common in the coming few months, and more diluted steroids, or steroid creams used once or twice a week, will prevent the flare.

  1. Steroid creams are dangerous, they damage & thin skin, or cause stretch marks

This only happens when people use over strong steroid creams, and for longer than they should. If the steroid is the right strength, and diluted is best, the safety is considerably improved. In fact, there are no documented cases of skin damage after using very diluted steroids with anti-bacterials. Most people getting side effects are using the strongest steroids without using moisturiser, on delicate skin. The biggest danger, therefore is having stronger steroids on repeat prescription, without adequate monitoring on the amounts used. Doctors are very aware of risks, and tend to be cautious about quantities and strength for this reason. Over-caution leads to a course of action that may be too short for recovery.

  1. Steroid creams are un-natural, I prefer to stick to natural products

Our bodies produce cortico-steroids from the adrenal glands, which aid recovery of various organs, especially under stress. The adrenal glands sit just above the kidneys, Our bodies produce corticosteroids to regulate blood pressure, and our immune responses, including inflammation. More cortisol is produced by the adrenals after any physical trauma, infection, extremes of heat and cold, exhausting exercise, or stress. Cortisol is the most potent known anti-inflammatory, and acts against allergy. Steroid creams may be synthesised, but they are molecules which are copies of what our bodies produce naturally to stimulate recovery and suppress inflammation.

  1. I have heard that body-builders abuse steroids, so I don’t want them

People who wish to bulk up their muscles often use anabolic steroids, as these help the body make larger muscles or boost performance. Anabolic steroids are quite different to cortico-steroids, and tend to be derived from the male hormone, testosterone. These are properly known as androgens, and are mainly produced by the testicles. The term steroids may be misleading people, as there are several distinct categories.

  1. Antibiotics should not be over-used as this stimulates resistant bacteria

The antibiotics most associated with resistant bacteria, are those used in the farming and food industry to stimulate growth in chickens or other animals, often bred in over-crowded conditions, and used widely if not universally. So over-use is actually prevalent in farming and this may be more of a problem than in medicine. There are however some antibiotics used by mouth to treat a germ in the gut which are becoming ineffective. This germ is E Coli, not the staph we get on our skins. E Coli is a problem where sanitation is not very good, so travellers to remote areas lacking effective sanitation are most at risk. It is true that travellers who get diarrhoea treated with antibiotics may find they become carriers of resistant E Coli. Staph however, the commonest skin germ, remains extremely sensitive to two topical antibiotics, mupirocin, and fucidic acid. Although also sensitive to neomycin, this one is hardly ever used as many people become overly sensitive to neomycin and react to it. Mupirocin is often more effective than fucidic acid, even in MRSA – the most resistant form of staph. Mupirocin is commonly used to eradicate staph in hard to reach places, like the lining of the nose.

  1. My dermatologist has told me using bleach baths is a better way of getting rid of the skin bacteria than antibiotics.

Ok, I’ll admit it, bleach is extremely effective and kills more bacteria than mupirocin. However it is also very easy to get the technique wrong, since the bleach to bathwater ratio must be rather precise, and the bleach water mix must be removed when the child gets out of the bath, so the water must be drained, and the child rinsed with a shower head. Children dislike sitting in an empty bath when the water has run out, and dislike the shower afterwards. So bleach is often left on the skin causing further dryness and itching. Those parents who are able to manage bleach baths do say the method is extremely effective in managing eczema, since it does help eradicate staph. But when the skin is very inflamed, or bleeding, a topical antibiotic is better, more soothing.

  1. If the skin is infected with staph or other germs, it would be better to have a course of antibiotics by mouth.

Giving antibiotics by mouth kills the germs, and is effective. However, it also kills numerous healthy bacteria in the gut, for which our immune systems depend. Upsetting this colony of healthy bacteria – the gut microbiome – results in imbalance of healthy germs to unhealthy ones, and we can then suffer from diarrhoea. Many people now recognise this, and take probiotics to try and prevent this. However topical antibiotics work just as well, without these side effects, and it is better to just kill the germs you don’t want, than kill numerous ones you do want. For too long people have read the leaflet with their antibiotic, seen the diarrhoea, and thought “ok, I don’t need to be concerned about this, it is just a side effect”. Perhaps more people would be concerned to know this is a direct result of killing off healthy bacteria which aid the proper digestion of food in the gut. The healthy bacteria need to be in balance to properly regulate our immune responses.

  1. My child will eventually grow out of eczema, so there is no harm just using the creams my doctor prescribed until this happens.

Actually nothing could be further from the truth. We now know that atopic eczema is the initial manifestation of an “allergic march” or “cascade” through several body systems. First the skin, then the lining of the air passages, trachea and bronchi in the lungs, the lining of the middle ear, then leaky gut, and allergies to proteins we normally eat, like peanut, other nuts, milk, and eggs. Some people will go on to develop life threatening allergies and need epipens to use in case of anaphylactic shock. So just ignoring the immune system problems is not only silly, but actually quite dangerous in many cases. All the atopic illnesses have a common root, defects in the gluing together of lining cells, leak of proteins or germs, too much histamine or immune response, and eventual harm to our immune systems.

It would be so much more sensible to treat atopic eczema as an atopic disease – and treat the gut and the immune system at the same time, thus preventing deterioration of eczema into a chronic condition, and preventing asthma, allergic upper air passage disease like glue ear, and allergic rhinitis.

  1. Eczema is worse than dermatitis

Actually dermatitis and eczema are just two terms for skin inflammation. Dermatitis is a term more used in USA and parts of Europe, and eczema more common in the UK. The word eczema comes from the Greek. We have numerous Greek words in common use in English, such as planet, sarcasm, phobia, panic, music and marathon. I think we like words with a history, or with an association here in the UK. We tend to use the term “glue ear” instead of serous otitis media, and the term “runner’s knee” rather than ileo-tibial band syndrome. I’m sorry I think I am digressing. So, no. Eczema is not worse than dermatitis. If you visit a doctor or MD as they are known in USA, you may be told you have atopic dermatitis, or AD. Same thing, different country, they have plenty of different words there.

  1. Chronic eczema is eczema that has got much worse

Doctors use the term acute for something that blows up quickly, and may settle quickly, and chronic for a disease that lasts a longer time. In my view chronic eczema is imply atopic eczema that has been allowed to last a very long time, even forever, because not enough was done at a young age to prevent the immune system adjusting and returning to normal function. There are many chronic diseases that occur because our understanding of the process is continuously developing, as medical science advances. There are things we understand better today than ten years ago.

  1. Eczema is contagious

Children and adults can be very embarrassed about their physical appearance with eczema. It is very common on the face, and there is a natural reaction that others have of not wishing to touch it. Perhaps this explains why people think it may be contagious. However it is not a contagious disease. However those who have broken skin, or scratched eczema are more at risk of catching a contagious skin disease like herpes, (cold sore) or molluscum (a kind of wart virus).

  1. If I stop my child scratching and constantly itching, it will get better

This presupposes that a child can control their scratching, and it can be prevented adequately by wearing a mitten or clothing over the hands. Itching with atopic eczema is constant, and not only at night. It is true that scratching may further damage the skin barrier and cause bleeding, but the germs can gain entry through the skin even without scratching. People with eczema have defects either in the glue that binds the cells together on the skin – fillagrin, or in the ceramides, which cause waterproofing. Children scratch because the skin does not feel good, it is very dry, and it is impossible to stop scratching without the right kind of creams on the skin to treat the eczema.

  1. You can’t go into a swimming pool if you have eczema.

Swimming pools are treated with chlorine, a kind of bleach, to kill germs that might otherwise harm people or make the water look green or murky. So because of the chlorine, the skin is also cleaned of germs. However, after swimming, one should rinse off the swimming pool water. And then moisturise when the skin is clean. Swimming is actually excellent exercise for children and adults with eczema, but care should be taken to shower and moisturise afterwards.

  1. Chinese medicine is more effective for eczema than western medicine.

In fact, numerous studies have shown that Chinese herbalists who provide cream have been adding corticosteroids to their mixtures for years. The dilution does vary quite a bit, so one is never very sure how much steroid is in the cream. For this reason, the subterfuge, and the varying quality, western doctors dismiss these claims. I imagine there may be very competent practitioners of Chinese traditional medicines who are extremely good at treating eczema, but it is unlikely that you will find them selling their creams on the internet.

  1. Eczema can be permanently cured

We all wish it were this simple. It is certainly possible to cure people with mild disease, and moderate disease in many cases with good care. It does seem that we are making progress all the time with better understanding of our micro-biome, our genetics, and with targeted therapies. However, no-one should promise a cure. We should aim for best management using the drugs and nutrition, and healthy living habits that appear to be the best route to health.