Balancing online facts and an expert’s take

E’s regular paediatrician recently prescribed him an ointment named Protopic to treat his eczema. I had previously expressed my concern about the use of steroid-based creams and how I have isolated the ‘collection’ we have at home. Priced at RM200+ for a tiny 30g tube, we contemplated for a while before decided to try out Protopic.

Within a day of applying the ointment, E’s rashes subsided by around 70% appearance-wise. Minus some minor spots here and there, his skin went back to normal the following day. As the ointment gave him some burning sensation after application – judging from his reaction – I decided to do a research on Protopic and was shocked to discover that:

* It should only be used if all other medications (eg. steroid-based cream) cease to work.
* It is not safe for children younger than 2 years old. There are two concentrations of Protopic, namely the 0.1% for adults and children who are at least 16 years old, while anyone younger than that should use the 0.03% concentration. E was prescribed the former (!!!).
* Protopic has been linked to causing skin cancer or lymphoma although not entirely proven.

I panicked big time. Guilt, anger, confusion…you name it, I felt it. I just put on a cancer-causing cream on my child! Only a foolish mom will put her entire trust on an expert’s words. Bear in mind that I have always had huge respect for Dr Ling’s work. He’s one of the most responsible, dedicated and caring paediatricians we have come across so far. By talking to him, you will be able to sense his sincerity and passion in treating children. Okay okay, I admit his Patch Adams’ balloon sculpting skills won me over too… And it’s really rare to come across genuine doctors like him.

I couldn’t help but to ponder, is Protopic stronger and possibly more damaging than steroid-based creams? Will there be any horrible side effects we should be aware of in the long term? I found myself hiding the ointment deep beneath the clothes drawer. GO ROT AWAY THERE!

You know how sometimes we shouldn’t believe entirely what we read on the Internet? I decided to investigate. Armed with the facts I have gathered online, I shot an email to Dr Ling Shih Gang. His reply was not only detailed and shedded light on the concern, but also taught me a little about balancing my judgements, dissecting the context matter and be more in-depth minded. I’m sharing his reply as it is:

1. protopic as last option?
Yes and no. Yes because for some children whose eczema is very persistent, continuous usage of steroid based creams would be detrimental. protopis is steroid-free and therefore can be used regularly. No because for some parents who have phobia regarding steroid use, i prescribe protopic as first line.

2. protopic stronger and more damaging?
If you talk of stronger as being more effective probably not so as it is of equal potency as medium strength steroid cream. in terms of side effects, happiness –no steroid side effects! not much of other major side effects. maybe more damaging to our pockets! really costly! about 10x more!

3. not safe for children under2 years old?
to say it is not safe for those under 2 years old would be inaccurate. a better description would be that its safety is not tested in those below two and therefore unknown. having said that, almost all medications would have problems being tested in young children as it would be difficult getting participants. most medications including many we happily use for young children such as paracetamol have also never undergone such testing. only thru time sometimes can we be definitively certain of its safety.

4. 0.1% for adults , 0.03% for children/
you are right. that is the recommended prescription. however, whenever i use the adult strength, it is only once a day whereas the actual frequency is twice a day. i believe the potential of this causing side effects is negligible.

5.damaging side effects?
if there is any inkling of damaging long term side effects, i would not have prescribed to any patient, and FDA would not have approved its use at all. i believe its side effects if any is far less compared to steroids.

6.Protopic causing cancer?
studies done on tacrolimus (real name of protopic) has shown high safety profile when used topically. some studies showed cancer development but that was done in mice where they injected mice with 150 times the normal dose. applying topically is very diffenr from injecting and to use 150 times the dose, any medication used may also lead to cancer.

7. Online research?
very hazardous and misleading. you will always be able to find view supporting or opposing a particular issue. from vaccines causing mental retardation to water causing cancer, you will surely find it.

8. To use protopic?
If you feel uncomfortable after your brief research online, maybe you can search more or get opinions from more doctors on this. if you still feel uncomfy, then don’t use it, maybe switch back to steroids or other moisturizers. if i were a parent i would be more than happy to use it on my children. i would not prescribe your child a medication i myself would not prescribe my own children.
With that, I won’t say that I will use Protopic on E on a consistent basis, but only when it’s really required ie. it’s affecting his personality/sleep, he can’t function well from the constant itch etc. And of course, even when it is used, I’ll make sure that the prescription dosage is followed very closely – only a very thin layer once a day.

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5 thoughts on “Balancing online facts and an expert’s take

    1. joeyllhow

      You have eczema too? Does any of your kids get that to? What are the allergen triggers and how have you been managing it? Let’s compare notes!

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