Intended for healthcare professionals


Chinese herbal remedies may contain steroids

BMJ 1994; 308 doi: (Published 12 February 1994) Cite this as: BMJ 1994;308:473
  1. R A C Graham-Brown,
  2. J F Bourke,
  3. G Bumphrey
  1. Department of Dermatology, Leicester Royal Infirmary, Leicester LE1 5WW.

    EDITOR, - Virtually everyone in British medicine must be aware of the current vogue for Chinese herbal remedies for treating eczema. The issue has received much press coverage recently. We wish to alert readers to the fact that Chinese herbal remedies may not be all they seem.

    Last year one of us (RACG-B) appeared in a television documentary that looked at the treatment of eczema with Chinese herbal remedies. We subsequently received a substantial volume of correspondence, including a letter from a young woman who had had lifelong eczema. She described having received Chinese herbs and some cream from a Chinese practitioner in Soho. By trial and error she had found that only the cream had any appreciable effect on her skin. She was convinced that the cream contained a steroid because it seemed to behave just like steroid creams she had received in the past. She also stated that other patients receiving treatment at the same time had received a similar cream. She sent us a sample of the cream for analysis. Although the quantity we received was not sufficient for us to identify the compound precisely, it definitely contained a steroid, possibly fluocortolone or prednisolone.

    Correspondence on Chinese herbal remedies indicates that the prescription of topical steroids by Chinese practitioners may be widespread. Dermatologists from Manchester1 and Nottingham2 have reported cases in which this occurred. Furthermore, Dr David Atherton, one of Britain's leading proponents of Chinese herbal medicine for the treatment of eczema, has become suspicious that some creams prescribed by Chinese practitioners contain strong steroids.3

    This highlights two important issues. Firstly, Chinese herbal practitioners claim benefit from “natural” remedies while also issuing patients with topical steroid creams. Thus claims of efficacy for the Chinese herbal remedies are suspect. Secondly, the only topical steroid that is supposed to be available without a licensed prescription is 1% hydrocortisone, so Chinese practitioners throughout Britain may be flouting the law. This should be investigated urgently by the appropriate authorities.