In August 2014, the local media in Hong Kong reports a case of illegal prescription of the topical corticosteroid (CS) triamcinolone acetonide to a child with eczema by a Chinese medicine (CM) practitioner.[1] The eminent CM practitioner is depicted as a "divine doctor for childbirth", and illegal prescription or sale of CS as a class I poison considered a criminal act. In November 2011, another eminent CM practitioner, also known as "holy hand for eczema" was charged for causing Cushing syndrome in a number of children with eczema who had unknowingly received CS whilst receiving acupuncture therapy.[2] In 2006, a complementary and alternative medicine (CAM) practitioner was charged for processing and prescribing CS.[3] The CAM practitioner, also known as "Father of Naturopathy", allegedly discouraged patients from using legally prescribed CS for treatment of common atopic diseases.

 

Like asthma and allergic rhinitis, childhood eczema is a common atopic disease which is associated with chronicity and impaired quality of life of the patients and their families.[4,5] Management generally includes patient education, avoidance of triggers, regular use of emollient and appropriate use of topical CS.[6,7] Nevertheless, myths and non-adherence on various therapeutic aspects prevail and management of this disease remains suboptimal.[8] CS is the firstline treatment during disease flare.[6] Steroid phobia, however, has largely restricted the usefulness and efficacy of therapeutic CS.[9-13] In Hong Kong, many parents would seek alternative and folklore treatment of unproven efficacy.[14] Paradoxically, some of these alternative treatments may contain potent CS and unknowingly used by steroid phobic parents.[8,15]

 

Eminent CM practitioners are especially tempted to prescribe CS to preserve their reputation that CM is efficacious in the treatment of any disease. It may be difficult to convince anxious steroid phobic parents to be cautious in the use of often adulterated proprietary CM. Nevertheless, the media has an important role not to directly disgrace CM and indirectly tarnish CS usage. Scientifi cally, CM is an important branch of medicine, and topical or systemic CS is a very important class of immunomodulating and anti-inflammatory medication. Steroids are inexpensive and efficacious armamentariums. They are often lifesaving in management of such severe diseases as life-threatening asthma, anaphylaxis, systemic inflammatory disorders and even childhood malignancies (such as leukemia and solid brain tumors). In Hong Kong, both CM and CS have important roles in disease management. The media should understand that the culprit is not CM or CS but rather the irresponsible practitioners. Tarnishing CS usage certainly does not help with the already evil image of CS among steroid phobic parents. Western and CM practitioners and the media should work together to promote correct public health education on this important class of medicine. Money is not evil but the love of money is the root of all evil. CS is defi nitely not an evil.