Doctor replies to 'Doctor prescribed unsuitable rash cream' (ST,
Feb 23)
Feb 28, 2006
Safe to use rash cream on young infants
I APPRECIATE Ms Ruth Tan Yueh Herng's vexation over her child's
skin condition in 'Doctor prescribed unsuitable rash cream' (ST,
Feb 23). But her letter contains a few misperceptions.
First, this was not the first time Ms Tan had visited our clinic
for her child's eczema. It was their third visit for the same
condition.
A steroid cream prescribed in a previous visit was obviously
ineffective. In fact, Ms Tan had mentioned that the rash was not
responding to treatment elsewhere.
As the eczema was severe, a second line medication like Elidel 1%
or Protopic 0.03% is in order. This was a considered prescription
and not a careless one as mentioned.
The question is: Is Elidel safe in the dosage and duration
prescribed? Elidel is an approved drug in Singapore, USA and other
countries.
When the US Food and Drugs Administration approved the drug in
2001, the studies were based on children two years and older. Since
then, there have been published studies showing that Elidel is safe
for use as a topical skin medication in children three months and
older.
As a result, the following countries have approved Elidel for use
in children three months and older: Australia, Hong Kong,
Indonesia, Malaysia, New Zealand, Pakistan, Philippines, and
Thailand.
In Singapore, a multicentre trial involving the National Skin
Centre, Changi General Hospital and National University Hospital
has been initiated to establish the efficacy and safety of Elidel
1% cream in infants.
Perhaps this is why the Health Sciences Authority has not yet
updated its recommendation for the use of Elidel 1% in young
infants.
Both steroids and Elidel work by suppressing the immune system.
Theoretically, both could cause cancer.
Indeed, oral and injectable steroids and Elidel have been
implicated in studies to be carcinogens.
However, the topical forms of these drugs have been found to be
very safe in large-scale use.
Topical steroids have been in use for decades while there are over
seven million users of Elidel 1%. Studies have shown that such
creams have minimal penetration beyond the skin and are not well
absorbed into the body.
I understand Ms Tan's frustration when her email went unanswered.
But she had chosen to email Thomson Medical Centre instead of our
clinic.
We could have clarified the matter and saved her unnecessary worry.
We would also have told her that I was called to attend to an
emergency Caesarean section immediately after the
consultation.
It was unfortunate but my patients who have further queries will
wait for my return, which takes up to 15 minutes. If this had upset
her, I apologise.
Dr Ang Poon Liat
