Chinese herbal medicine has a key role to play in the eczema crisis

https://www.rchm.co.uk/articles/bbc-coverage-of-topical-steroid-withdrawal-tsw-and-the-plight-of-eczema-patients

Two BBC News investigations by health reporter Ruth Clegg, published on 29 March 2026 and 11 April 2026, have brought the issue of topical steroid withdrawal (TSW) to national attention, generating millions of readers and hundreds of personal testimonies from people living with complex, treatment-resistant eczema.

Sunday 29th March - Our skin is falling off and no-one can tell us why - https://www.bbc.co.uk/news/articles/cx26pzpr71ko

Image source - BBC - https://www.bbc.co.uk/news/articles/cx26pzpr71ko & https://www.bbc.co.uk/news/articles/cly6xjpx6gjo

Saturday 11th April - Hundreds contact BBC about mystery skin condition 'hell' - but doctors can't agree it exists - https://www.bbc.co.uk/news/articles/cly6xjpx6gjo

The articles describe patients who have spent years relying on topical steroids that are no longer working, who feel unheard by the medical system, and who are turning - in some cases paying significant sums - to unproven private therapies out of desperation. They describe a genuine gap in NHS provision for some of the most challenging presentations of inflammatory skin disease.

The Register of Chinese Herbal Medicine (RCHM) recognises these patients. They are the patients who come to qualified Chinese herbal medicine practitioners when conventional treatment has not provided adequate relief. We are issuing this statement to ensure they know that a legitimate, evidence-based option exists.

Chinese herbal medicine is not a fringe alternative

The evidence base for Chinese herbal medicine (CHM) in the treatment of eczema is substantial and spans three decades. In the early 1990s, dermatologists at Great Ormond Street Hospital conducted a series of randomised, double-blind, placebo-controlled trials on a ten-herb formula known as Zemaphyte. Both the paediatric and adult trials demonstrated significant benefit over placebo and were published in The Lancet and the British Journal of Dermatology. One-year follow-up studies confirmed that benefit was sustained.

In the decades since, a Cochrane systematic review, a 2022 meta-analysis of eight high-quality randomised controlled trials involving 662 patients, and a 2023 systematic review of 17 trials covering 1,624 patients from infancy to adulthood have all confirmed that the published evidence shows CHM produces clinically meaningful improvements in eczema severity, itch and quality of life, with a consistently acceptable safety profile when properly sourced herbs are prescribed by qualified practitioners.

Mechanistic research published in 2019, 2020 and 2025 has mapped CHM's effects onto modern pharmacological understanding of eczema - demonstrating that herbal formulas act simultaneously on inflammation, immune dysregulation, barrier dysfunction and microcirculation. This is not a one-pathway intervention. It is precisely this multi-mechanism approach that makes CHM well suited to a multi-factorial condition like eczema.

The individualised approach matters

One of the recurring themes in the BBC coverage is the failure of a one-size-fits-all approach.  Steroid creams are usually prescribed, then repeated when they stop working, with no deeper assessment of what is driving the skin condition. Chinese herbal medicine works differently by design.

Qualified RCHM-registered practitioners are trained to differentiate between presentations of eczema that look similar externally but arise from different underlying patterns - hot, inflamed skin; weepy, oozing skin; dry, cracked skin; itch driven by different mechanisms. The skill of the practitioner lies in reading the full clinical picture and adjusting the prescription as the patient's condition changes. This is not an abstract concept: it is precisely the individualised, adaptive approach that fixed conventional protocols cannot provide.

Many RCHM members have extensive experience in Chinese medicine dermatology. This equips them with an understanding of complex, chronic and treatment-resistant skin disease. These practitioners are particularly well placed to support patients who have exhausted conventional treatment options.

Our position on topical steroid withdrawal

The RCHM does not claim that Chinese herbal medicine is a treatment for topical steroid withdrawal as a defined clinical entity. TSW is insufficiently characterised at present for any such claim to be made responsibly. We note that dermatologists themselves do not yet agree on its precise definition or treatment.

What we can say is that RCHM-registered practitioners - particularly those with specialist dermatology training - have decades of clinical experience supporting patients with complex, long-standing, treatment-resistant inflammatory skin disease. The individualised diagnostic approach of Chinese medicine may be well suited to this patient population. Any patient considering CHM should do so in communication with their GP. We do not encourage patients to stop prescribed medication without medical advice.

As RCHM President Martin John puts it:

"Chinese herbal medicine should not be invisible in conversations about eczema care. It is not a fringe alternative. It has a peer-reviewed evidence base, a skilled and registerable professional body, specialist-trained practitioners with decades of clinical experience, and a clinical tradition of over two thousand years. It deserves to be part of the conversation about what integrated, patient-centred eczema care looks like in the UK."

How to find a qualified practitioner

RCHM members such as Nicola Court, hold appropriate qualifications in Chinese herbal medicine, carry professional indemnity insurance, use properly sourced and authenticated herbs, and are bound by a code of professional ethics. In the absence of statutory regulation - which the RCHM has long called for and which a parliamentary investigation recommended but which has not yet been enacted - the RCHM register remains the most reliable way for patients to identify a qualified, accountable practitioner.

We encourage anyone seeking support for eczema or related skin conditions to use the RCHM practitioner register, and to ask about practitioners' specific experience in dermatological conditions.