The controlled and supervised use of topical steroids is a very effective and safe treatment for eczema. However, some patients would purchase strong topical steroids over the counter overseas, which can lead to uncontrolled and unsupervised use, said Dr Mark Koh, head of dermatology service at KK Women's and Children's Hospital.
He pointed out that some traditional medications contain steroids but may not have the appropriate labelling to indicate their content.
"Another group of patients may go doctor-hopping, requesting oral steroids whenever they get a flare of the eczema," he said.
"Repeated oral courses of steroids can lead to problems like poor growth, high blood pressure, diabetes, stretch marks and cataracts, among others."
On the other hand, there is a group of parents who have steroid phobia, where they exhibit an inappropriate amount of fear towards using topical corticosteroids in treating eczema, said Dr Koh.
For instance, they may worry that their child will need a stronger steroid cream after using a lower strength one for some time.
But that is because the skin naturally thickens as the child grows, said Dr Koh. A stronger cream is thus needed to penetrate the skin.
Chronic scratching from poorly controlled eczema can also lead to thickening of the skin, he said. "When parents stop using topical steroids too early or too sparingly, the eczema is not optimally controlled, and it flares quickly when the child is again exposed to triggers like dust or stress."
Poorly controlled eczema can result in repeated hospital admissions, poor sleep, slow growth and worsening school performance for the affected child, he cautioned. "Together with a daily skin moisturising regimen, topical steroids, when used in the right strength, amount and duration, is still the mainstay of eczema treatment."