SignalTrace

Adulterated Herbal Creams

John Montgomery7 min read

Adulterated Herbal Creams

"Natural" eczema creams can contain hidden strong steroids

Herbal, “Chinese”, “natural” or “steroid-free” creams bought online, from herbalists, market stalls or relatives abroad have repeatedly been found to contain undeclared prescription steroids, most often very potent Clobetasol Propionate. A cream that clears a toddler’s eczema “like magic” and lets it flare as soon as it runs out is a warning sign. Stop using it, keep the pot, and show it to your GP or pharmacist. If it has been used daily for weeks over large areas, ask a doctor before stopping, because the body’s own cortisol output may be suppressed. In the UK, a genuine registered herbal medicine carries a THR number or logo.

Adulterated herbal creams are skin products sold as herbal or traditional remedies for Atopic Dermatitis that secretly contain licensed drugs. Laboratory tests most often find Topical Corticosteroids (clobetasol propionate, dexamethasone, betamethasone valerate), sometimes with antifungals. The claimed mechanism is plant extracts that soothe inflammation without steroids. The real reason they work is usually the hidden steroid. That is why they appeal so strongly to parents with Steroid Phobia: in a Birmingham study, families bought them because they feared the side effects of prescribed steroid creams, and said the herbal products “worked extremely well” (BMJ press release on Ramsay et al., 2003). Many families came back to the clinic only when they could no longer afford the creams (often over £25 a jar) and the eczema flared again.

Adulterated Herbal Creams [part-of] Herbal and Home Remedies for Eczema Adulterated Herbal Creams [part-of] Topical Corticosteroids Steroid Phobia [causes] Adulterated Herbal Creams Adulterated Herbal Creams [treats] Atopic Dermatitis

Strength of evidence that adulteration happens: strong. Independent lab analyses and regulator testing agree. In 1999, Keane et al. (BMJ) tested 11 Chinese Herbal Medicine creams from 10 patients (7 of them children) supplied by five south London herbalists. Eight contained dexamethasone, at a mean of 456 µg/g (range 64–1500 µg/g in the abstract; the paper’s table lists 60–1512). That is roughly as strong as 0.05% betamethasone valerate, a potent steroid. Every cream prescribed for eczema contained it. Creams given to children had 5.2 times more dexamethasone than those given to adults, and the highest concentration was prescribed for the face of a 4-month-old baby. In 2003, Ramsay et al. (Arch Dis Child) analysed 24 “herbal creams” from 19 children (median age 3.8 years) at Birmingham Children’s Hospital. Twenty contained steroids. All five Wau Wa and both Muijiza creams contained clobetasol propionate, and Wau Wa looked like about 20% Dermovate (a prescription clobetasol cream) mixed into paraffin. Thirteen of 17 unlabelled creams also contained steroids. No parent knew. These are small clinic samples, so they show that adulteration is common among creams parents rate as “miraculous”. They do not show how common it is across the whole market.

Chinese Herbal Medicine [relates] Adulterated Herbal Creams Adulterated Herbal Creams [relates] Clobetasol Propionate Adulterated Herbal Creams [relates] Clobetasone Butyrate Adulterated Herbal Creams [relates] Hydrocortisone

Regulatory cases. The MHRA has issued named warnings. In early 2018 it reported that Yiganerjing Cream, sold in the UK as a “natural” Chinese herbal medicine for eczema, psoriasis and rosacea, contained clobetasol propionate and two antifungals. It also named Penny Orange Cream, supplied through a herbal clinic, as containing clobetasol. In December 2018 it found the same steroid in Zudaifu cream and moved to take it off websites and online marketplaces (MHRA 2018a; MHRA 2018b; PAPAA). The MHRA says that selling potent steroid creams directly to the public is illegal, that clobetasol is contraindicated under 1 year of age, and that parents should stop using these products immediately, “particularly on young children and babies”. It advises checking for a Marketing Authorisation, Product Licence or Traditional Herbal Registration number before trusting a “herbal” medicine. Keane et al. described a pattern going back to the 1990s, and the same products keep reappearing online because unlicensed creams are easy to relabel and resell.

MHRA [regulates] Adulterated Herbal Creams MHRA [opposes] Adulterated Herbal Creams Traditional Herbal Registration [prevents] Adulterated Herbal Creams

Toddler safety and clinical consequences. A hidden very potent steroid used without medical supervision is risky for under-5s. Toddlers have a high skin surface area relative to body weight, and these creams are put on thin skin (face, flexures, nappy area), often several times a day. Wau Wa’s label said to apply it “all over”, which for an average 4-year-old means about 135 g a week (Ramsay press release). The authors list irreversible Skin Atrophy, spread of infection, rebound worsening of eczema, growth retardation and impaired adrenal output. Keane et al. warn that hidden steroids can badly worsen Eczema Herpeticum. In one of their cases, a dexamethasone cream prescribed by a herbalist for eczema herpeticum was followed by an exacerbation. Case reports of unsupervised clobetasol use show where this can lead. Razzaghy Azar et al. (2015) describe three young children, including an 11-month-old who had clobetasol 0.05% applied 6–7 times a day for months, who developed Iatrogenic Cushing Syndrome (moon face, blood pressure of 170/100, height −4 SD) with HPA Axis Suppression. Hypertension continued after stopping in two children, and one lost vision permanently. That series involved openly used clobetasol rather than an adulterated product, but the drug and exposure pattern match. Stopping suddenly after long heavy use can also cause a rebound flare, sometimes described as Topical Steroid Withdrawal. These harms come from unsupervised overuse of potent steroids. They do not mean prescribed steroids are unsafe: correctly prescribed mild steroids in toddlers carry low, mostly reversible risk (see Topical Corticosteroids).

Adulterated Herbal Creams [causes] Skin Atrophy Adulterated Herbal Creams [causes] HPA Axis Suppression Adulterated Herbal Creams [causes] Iatrogenic Cushing Syndrome Adulterated Herbal Creams [worsens] Eczema Herpeticum Adulterated Herbal Creams [precedes] Topical Steroid Withdrawal

Traditional use and what parents report. These products trade on the reputation of traditional Chinese, South Asian and East African herbal practice. The creams in the studies came from Indian and Pakistani herbalists in Birmingham, Leicester and London, from mail order, and from relatives in Pakistan and Tanzania (Ramsay press release), or from Chinese herbalists in south London (Keane). Parents in both studies said the creams worked very fast and well and believed they were steroid-free. Their eczema got worse when the supply stopped, either because the money ran out or because they reached the clinic. This pattern is consistent with steroid response and rebound (evidence: anecdotal; parent reports collected in clinic studies). Clinicians suggest treating any “miracle” herbal cream with suspicion and asking parents directly about herbal products when a child shows unexplained skin thinning, cushingoid features or a sudden severe flare.

Herbal and Home Remedies for Eczema [relates] Adulterated Herbal Creams Steroid Phobia [relates] Adulterated Herbal Creams

Connections

Graph View

Backlinks