Experts demand traffic-light labels to show strength of steroid eczema cream to end confusion

Tubes of eczema ointment should be branded with traffic light ratings to avoid confusion about how strong they are, experts say.

The drugs, called topical steroids, are used by millions of Britons – and are a mainstay of treatment for the condition, which causes skin to become itchy, dry and cracked. But campaigners say patients are “flying blind” with no easy way to know their potency because, surprisingly, the strength of the drugs is never on the packaging and rarely in the accompanying patient information leaflet.

Doctors say some patients unknowingly use too many potent versions, increasing the risk of painful withdrawal symptoms when the course ends.

These include redness, ‘burning’ pain, excessive flaking of the skin and severe itching, which patients say are different from normal eczema flare-ups – and can be so severe that they cause insomnia and psychological problems such as anxiety and depression.

Meanwhile, experts say others are underapplying because they’re unnecessarily concerned about side effects, meaning their skin problems aren’t being properly controlled.

That’s the concern the National Eczema Society wrote to the Medicines and Healthcare Products Regulatory Agency (MHRA) last week, urging it to “require pharmaceutical manufacturers to display clear potency labels on topical steroid tubes, packaging and patient information inserts.” to introduce’.

Also signed by the British Association of Dermatologists, the open letter continued: ‘The aim is to achieve a level of public understanding comparable to the strength of sunscreens using Sun Factor Protection (SPF) labelling.’

Andrew Proctor, managing director of the National Eczema Society, said: “It’s left to health professionals to explain what potency is,” he said. ‘During busy consultations there is not always time or patients may not remember. A pack of paracetamol will tell you exactly how much you can safely take – the same should be the same for topical steroids. At the moment, eczema patients are flying blind.’

The condition affects one in five children and one in ten adults in the UK. It occurs due to both genetics and environmental factors such as allergies, and is incurable.

Topical steroids — also known as corticosteroids — reduce inflammation, suppress immune system overactivity, and constrict blood vessels, which helps relieve some symptoms, such as itching and pain, easing the urge to scratch so the skin can heal. There are over 100 different types of topical steroid preparations available in the UK, broadly grouped into four categories of potency: mild, moderate, potent and very potent.

A moderately potent steroid is twice as strong as hydrocortisone one percent — the mild type — and both are available over the counter. High potency steroids are ten times stronger and high potency steroids are at least 50 times stronger.

But this basic information is not on the packaging – instead, the concentration of active ingredients is printed, usually in percentages. But the potential for confusion is obvious: betametasone 0.1 percent, for example, is a potent steroid that is ten times as strong as hydrocortisone 1 percent.

Professor Celia Moss, consultant dermatologist at Birmingham Women’s and Children’s NHS Foundation Trust, said it was ‘a mystery’ why pharmaceutical companies failed to make things clearer. She said: ‘A few years ago the MHRA stipulated that all skin lotions containing paraffin must have a fire risk warning on the packaging, even though that risk is very small. They need to do something similar to address the confusion over topical strengths of steroids.

‘A traffic light system would be great, as we are used to on food packaging.’

Labels may indicate green for the mildest formulas, amber for moderate, red for strong, and darker red for very strong.

Topical steroids are usually intended for short-term use of two to six weeks. For the majority of eczema patients, symptoms will ease during this time. Those with more severe eczema may need to use stronger creams for longer periods, which should be monitored as the risk of side effects increases.

A 2021 MHRA review said withdrawal could occur “after prolonged continuous or inappropriate use of moderate to potent products.”

Professor Anthony Bewley, from the British Association of Dermatologists and a dermatologist consultant with Barts Health NHS Trust, said: ‘A minority of patients using topical steroids find their skin getting worse, not better, and need to apply more. If they stop, they will have serious skin problems. We don’t know why, but it’s mostly seen in people who use potent topical steroids unsupervised for years.

“Instructions can be vague – leaflets speak of applying ‘sparingly’ or ‘enough to cover the affected area’, which isn’t good enough.”

Topical doses of steroids are measured in ‘finger point units’ or FTUs. One FTU—enough ointment to cover the tip of an adult finger from the tip to the crease of the first joint—should be applied to an area of ​​skin the size of two adult hands, holding the fingers together.

‘Using less may mean that the symptoms are not under control, so the patient is using more for a longer period of time, increasing the risks,’ said Prof Bewley.

The drugs, called topical steroids, are used by millions of Britons – and are a mainstay of treatment for the condition, which leaves skin itchy, dry and cracked (file photo)

Prof Moss said there is also a problem with patients avoiding steroid use for fear of extreme withdrawal symptoms.

Studies suggest that up to eight in ten are concerned about using topical steroids.

‘It’s a problem with people who are unwilling to use even mild topical steroids even if they would benefit, as they’ve read about withdrawal symptoms,’ added Prof Moss. “Better labeling would help.”

A National Eczema Society survey found that only 17 percent of eczema sufferers knew how many strengths there are with topical steroids.

One eczema sufferer who understands the confusion is Ellen Vincent, who was diagnosed as a child.

The 43-year-old, who lives in Cheltenham, Gloucestershire, said: ‘Like many people with eczema, I use topical steroids of varying strengths on different parts of the body.

“Sometimes I use three at once and can get confused. There is a risk of accidentally using a strong one where you should be using a mild one, and vice versa. The tubes are often very similar.

‘Better labeling on the packaging would help enormously.’