More worrisome than allergies is the long term damage of topical steroids, which increasingly are shown to be every bit as dangerous as their orally delivered cousins. Indeed, researchers at New York University throw topical and systemic steroids into the same pot, warning that "their use is not without potential complications" (Dermatological Clinics, July 1992).

Topical corticosteroids can produce an array of serious skin problems (American Family Physician, July 1993; J of Derm, Aug 1991). They've been shown to damage organs, and cause permanent adrenal suppression (Zeitschrift fur Hautkrankheiten Apr 1988).

Children with asthma and eczema in particular often the most likely to be subjected to drug treatment are prone to the side effects of steroids (Arch of Disease in Childhood, 62, 1987), such as stunted growth and adrenal disease (The Lancet, 14 Dec 1991). One child covered with eczema from head to food from 18 months was treated once a day from age six with a layer of betamethasone ointment over his entire body; by age 13, he was 24 cm (about nine and a half inches) smaller than average. Although he enjoyed some catch up growth once steroids were discontinued, he never recovered what was estimated to be his likely size. "Every effort should be made to search for an alternative mode of treatment", concluded Dr Hans Henning Bode (J of Am Med Assoc, 22/29 Aug 1980).

In other instances topical steroids have also been implicated in Cushing's syndrome (moon face) in children, as soon as a month after treatment (Arch Dis Child, 1982; 57: 204-7). The authors concluded that topical steroids may impair pituitary adrenal responses, requiring systemic steroids during illness or trauma.

Even the supposedly mild hydrocortisone cream, which is even prescribed for babies, is known to have a myriad of side effects including thinning of the skin, especially the face, stretch marks, delayed healing or ulceration of wounds, suppression of adrenals, sugar in the urine and eye damage, such as glaucoma and cataracts (see WDDTYvol 1, no 11).

In fact, increasing evidence is emerging to suggest that topical and inhaled steroids can cause the eye damage cataracts and glaucoma ordinarily only associated with oral steroids (The Lancet, 20 November 1993, New Eng J of Med, 9 Dec 1993). Cases of psychotic episodes with inhaled steroids, ordinarily only associated with systemic use, are also coming to light (Ann Int Med, 15 Oct 1988).

Patients using systemic steroids who haven't had chickenpox can also be placed in great danger, as the well reported case of nine year old Lexie McConnell proved so tragically when she died of chickenpox after doctors failed to warn her parents of the side effects and dangers of a routine course of treatment (see WDDTY vol 4 no 8). Steroids suppressed her immune system and therefore made her more susceptible to serious infection.

About 30 people die each year from chickenpox, a third of whose deaths are associated with immunosuppression (Curr Probs in Pharm, Feb 1994). Indeed, in 1992, following reports of such deaths, the US Food and Drug Administration has asked manufacturers of oral and inhaled steroids to add a warning to their product labelling that children on immunosuppressant drugs are more susceptible to deaths from measles and chickenpox than healthy children (J Am Med Assoc, 15 January 1992).

The recent Evill and Coleman litigation highlights the threat of osteoporosis, one of the more serious side effects from taking steroids over a long period.