• • MARCH 28, 2025

  3 Months of Topical Steroid Use Necessitated 10 Months of TCM for Eczema Recovery

  A 13-year-old girl presented with a 7-month history of eczema in the cubital fossa area, initially mild and managed with moisturizers, but worsening itchiness led her to seek medical advice. Three months prior, her family doctor prescribed Combiderm Cream (a corticosteroid, antifungal, and antibiotic combination), which initially cleared the rashes, though they returned as the cream’s effects waned, depleting the 5-gram tube quickly. A dermatologist then prescribed a different steroid cream, but the eczema became uncontrolled, with persistent itching and flares, and the rashes returned each time steroids were discontinued, raising concerns about steroid dependence. Her parents, wary of long-term steroid use, sought alternative treatment at our Traditional Chinese Medicine (TCM) clinic.

   

  

  On initial consultation, the eczematous lesion appeared as a well-defined, darkened, thickened, and scaly patch with a hyperpigmented black tone, though the surrounding skin was relatively normal due to recent steroid use. We advised discontinuing steroids with a two-month wash-out period, during which the lesion worsened due to steroid withdrawal, becoming more inflamed, red, and swollen, with less defined borders and mild redness in the surrounding skin. A customized herbal regimen was prescribed with monthly follow-ups. One month into TCM therapy, the lesion’s redness slightly decreased, but it remained inflamed with an enlarged size, though the texture became smoother and the surrounding skin showed less irritation. From 2 to 4 months, the lesion steadily improved: its size decreased, color shifted from red to near-normal, inflammation reduced significantly, texture became smoother, and scaling nearly disappeared by month 4. At 6 months, a second, milder rebound flare-up occurred compared to the initial withdrawal, and by 8 months, this 2nd flare-up subsided, with reduced redness, no scaling, and normal skin texture. The lesion progressively resolved, achieving full recovery by month 10, demonstrating the effectiveness of continuous TCM therapy in managing her eczema without steroid reliance.

   

  Discussion

  In this case, the initial use of topical steroids, such as Combiderm Cream and subsequent steroid prescriptions, likely exerted a suppressive effect on the eczema by modifying gene expression related to inflammatory pathways, temporarily masking the symptoms. Steroids are known to downregulate pro-inflammatory cytokines and inhibit immune responses at a genetic level, which can lead to rapid symptom relief, as seen with the complete resolution of rashes upon application in this 13-year-old patient. However, this suppression does not address the underlying pathophysiology of eczema, and the rebound effect observed upon steroid withdrawal—marked by increased inflammation, redness, and lesion expansion—highlights the risk of dependency and the phenomenon of topical steroid withdrawal syndrome. This temporary genetic modification by steroids essentially “covers” the eczema without resolving the root cause, leading to a cycle of flare-ups when the medication is discontinued, as observed in this case.

  In this typical scenario, the patient’s 3-month use of topical steroids necessitated a 10-month course of Traditional Chinese Medicine (TCM) therapy to achieve full recovery, underscoring the challenges of transitioning from steroid-based management to a holistic approach. The initial steroid withdrawal phase exacerbated the eczema, as expected, due to the rebound inflammatory response, but the customized herbal regimen gradually restored skin homeostasis by addressing the underlying imbalances, as evidenced by the progressive reduction in lesion size, inflammation, and scaling from months 1 to 4 of TCM therapy. Despite a milder second flare-up at 6 months, the lesion continued to subside, achieving complete resolution by month 10. This prolonged recovery timeline reflects the time required for TCM to narmolize the immune response and repair the skin barrier without the suppressive effects of steroids, suggesting that while TCM offers a sustainable, steroid-free solution, it demands patience and consistent application to reverse the effects of prior steroid use and achieve lasting recovery.

  Privacy

  In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.

  • Case Reports

By Tony Tang Yuqi

Physician Tony Tang Yuqi leads Tangs Clinical TCM with a wealth of knowledge and experience. Holding esteemed qualifications such as an MSc in Clinical Research from Edinburgh and an MBA from Singapore, alongside a Diploma in Traditional Chinese Medicine and registration as a TCM Physician in Singapore. He believes in a compassionate and holistic approach to healthcare, especially when it comes to TCM treatment for eczema, providing comprehensive patient care.