@DV:
Only 1 patient so far has reacted to VCO, but this patient was later noted to have allergy to coconut as evidenced by several episodes of urticaria after ingesting any food with gata (kahit taste lang).
@trendy:
Topical steroids are safe to use as long as it is used properly and with guidance from a licensed medical professional. The problem starts when topical steroids are abused and used repeatedly and with the wrong diagnosis, etc. I have had several patients come to me with Urticaria, but was mistakenly given topical steroids as part of their initial management. Topical steroids are not used for the treatment of urticaria. Proper diagnosis is the 1st essential step. Second, look for triggers; do avoidance measures. Next, treat with either hydration of the skin by using emollients/moisturizers, having frequent baths, etc. If, however, this doesn't result in getting the AD rash controlled, then that is when there is a need to give topical steroids, anti-histamines, etc.
I come from a very atopic family. My brothers and I have AD, asthma, allergic rhinitis. My son has AD. His condition started when he was just 6 1/2 months of age when I first started mixed feeding him. He had weeping excoriations on both cheeks and he would constantly scratch them that he ended up having an excoriation near his eye (so disheartening), but lucky for us, I knew exactly what had triggered his AD and eliminated it right away. However, I knew that the cow's milk allergens would take a while to disappear from his system so I had to treat his skin lesions with topical steroids while I started him on soy milk and continued giving him pumped breast milk. It took about 2 sessions with topical steroids before his rashes went away (2 weeks use at each time) but his face eventually cleared up. He is 5 years old now and his AD just gets triggered by dust mites, sweat and weather changes but not as bad as when he first had it.
My own AD is triggered by cold dry weather (I'm also allergic to cockroach and molds, but not to dust mites) and usually shows up around Jan to Feb of each year. This year was pretty bad since my rashes wouldn't just go away with emollients (in fact a moisturizer I used aggravated it) so the only thing that cleared it was topical steroids coupled with 2nd generation anti-histamines.
So please understand that I know what AD patients go through because I get it every now and then and my son/brothers all have them.
Do topical steroids have the potential to cause adverse reactions? Yes. Just like any medication, whether natural or synthetic, it has the potential to cause adverse reactions, which is why there is a need to use them only as prescribed and never self medicate based on friend's recommendations, etc. Only doctors should prescribe steroids, whether topical or oral, because we are the ones who are knowledgeable about the need for steroids, their adverse effects, when to stop them, etc. This is also the reason why it is very important to follow up with your doctor. We tell patients to follow up, not because, we want you to spend money for our PF, but because we need to assess response, adverse effects, etc. We are not the enemy. Our goal is to help.
There are so many disturbing statements on the ITSAN websiste, One thing is glaringly obvious and that is the anti-doctor sentiment. I understand that this comes from being frustrated, you want your child to get better, you want yourself to get better, but why not come to the clinic , thinking I will be meeting with a doctor who can help me rather than go to the clinic with a hostile outlook? Let me tell you, it is very hard to work with a hostile patient/hostile parents, but we try our best to work with them, we try our best to explain treatment benefits, treatment options, etc. Trust is very important in a patient - doctor relationship.
Let me just address a few of the disturbing statements on the ITSAN website:
a. The need to stop inhaled steroids with asthma because inhaled steroids can also be addicting.
-- Poor poor asthmatic patient; I,myself, have encountered parents who refuse to nebulize their children, thinking it will make them dependent on the nebulizer meds and would rather take oral meds. The fact is oral beta agonists has more side effects compared to inhaled beta agonists. You also do not get addicted to nebulizing agents. If you do not treat your asthma, then you are at risk for complications.
Inhaled steroids are the mainstay of treatment with persistent Asthma, just as nasal steroids are the mainstay of treatment for allergic rhinitis.
b. Use of allergy tests to determine triggers
I might sound biased, but allergy tests have been proven to be a safe and effective way of identifying allergic triggers. Dermas would disagree with me, though...
Please understand, though, that food is not usually the only allergic trigger to look out for. House dust mites are also an important cause of AD. Food allergy is a highly overdiagnosed disorder, but in reality, it affects just 1 - 2 % of the adult population and 6 - 8% of the pediatric population.
Also, as I said before, AD may be triggered by both allergic and non - allergic triggers. Stress, in itself, can trigger AD. It is easier to avoid allergic triggers compared to triggers we cannot change like the weather, etc.
c. Skin asthma or AD is not an atopic disease
I read this from one of the blogs featuring TSA. Very, very disturbing because it is wrong and conveys the message that AD was actually caused by the steroids they used.
Can steroids cause ezcema? Oh, yes, but we call it contact dermatitis secondary to the use of topical steroids. Not atopic dermatitis. Different mechanism since it is a type 4 immunologic mechanism compared to the usual mixed type 1 and 4 immunologic mechanism of AD.
Contact dermatitis secondary to steroids is the reason why topical steroids are included in the patch testing panel.
By the way, AD that is not properly managed may lead to the development of respiratory allergies later on (asthma and allergic rhninitis).This is what we call Atopic march.
d. Steroids are generally harmful to your health
First of all, our own bodies produce steroids. Hormones are from the steroid pathway and we need them to regulate our systems.
Steroids are harmful if they are abused, if given for the wrong diagnosis, if taken/used beyond what is prescribed.
e. Forgive me, but Dr. Kligman has been describing this since 1979, and Dr. Rapaport since the 1990s, but why are there no proper research conducted on this? Dr. Rapaport should know that testimonial evidence is not admissible in medical research.
If it is that harmful, then why haven't they made any moves before to have it withdrawn in the market like what has been done with other meds that have been proven to be harmful more than beneficial?
Example, in 1979, terfenadine and astemizole were introduced in the market, but just 7 years after, they were withdrawn since they have been shown to cause cardiac toxicities when given in combination with macrolide antibiotics. Only 7 years...
By the way, I took oral steroids along with a bunch of other meds during my pregnancy since I had a very high risk pregnancy (had 3 miscarriages) due to a repro - immuno disorder (type 1 and type 5). I developed gestational diabetes as a consequence ( I was at high risk for GDM also due to family history), but it was a small price to pay for the successful birth of my one and only son.
AD that is not properly treated will really affect the quality of life of not just the patient, but the whole family as well.
Lastly, medical professionals acknowledge that there are a lot of misconceptions about steroid use, leading to steroid phobia in most patients but I encounter a lot of patients who didn't know that they've been using steroids/taking steroids. Most of the time, it's Celestamine, or in this thread, the post about Skineal which prompted me to reply and correct the information.
I apologize for the long post. I still have many things to say, but I hope this is enough to convey my message as a doctor, as a patient and as a mother of a patient as well.
Link to National ezcema association article on topical steroid myths:
http://www.nationaleczema.org/eczema-treatments/topical-corticosteroids
