“Doctor, I don’t want cortisone…”
In some patients, simply mentioning topical corticosteroids is enough to bring on… hives. Fear of side effects, steroid phobia picked up online, or a history of skin atrophy: the obstacles are many. Yet eczema cannot wait.
In this Simplycure webinar, biochemical engineer François Motte and dermatologist Dr Françoise Guiot set out a concrete option: the use of boswellic acids from Boswellia serrata, which can calm skin inflammation without resorting to cortisone.
In this article, discover their validated mechanisms of action and their real-world feedback from patients, backed by clinical cases.
Why consider treating eczema without cortisone?
As Dr Guiot points out: “In practice, we need options when corticosteroids are a problem.”
The situations are common: a child with atopic eczema whose parents refuse cortisone, an older patient whose skin is already atrophic, a sensitive site (face, skin folds, genital area), or patients with diabetes or glaucoma.
In these cases, boswellic acids offer a useful alternative, with remarkable tolerability: they target skin inflammation without immunosuppression and without the atrophy risks associated with topical corticosteroids1. A randomised clinical trial has also shown that a Boswellia serrata extract significantly reduced inflammation and itching in only 6 weeks2.
Boswellia serrata: mechanisms and safety
In the Simplycure webinar, François Motte recalls the thousand-year history of Boswellia serrata, used in India and China as an anti-inflammatory long before the era of corticosteroids3. Only recently has modern research made it possible to isolate and concentrate its active molecules: the boswellic acids.
How does it work?
Inhibition of the NF-κB/TNF-α pathway, involved in skin inflammation.
Selective blockade of 5-lipoxygenase, reducing leukotrienes.
Modulation of cytokines (IL-1, IL-6, IL-12).
An antiallergic effect through inhibition of mast cell degranulation.
The result is an action close to that of corticosteroids, but without the immunosuppressive or atrophying effect.
On tolerability, pharmacovigilance data confirm an excellent safety profile, including at high oral doses. Side effects are rare, often less frequent than in the placebo groups.
Another important point for practitioners: boswellic acids are not photosensitising. They can therefore be used before sun exposure, provided standard protection is applied afterwards.
What the studies and practice show
A controlled study cited by François Motte shows that topical application of boswellic acids gives a 70% reduction in itching and a 60% reduction in erythema within 30 days, with improved EASI (eczema) and PASI (psoriasis) scores.
Dr Guiot illustrated these results with several cases from her own practice:
a young girl with atopic eczema, eased in only 5 days,
an adult with nummular eczema whose lesions cleared within a week,
a patient with seborrhoeic eczema of the face, settled after 10 days of cream,
encouraging results too on actinic keratoses, radiation dermatitis and sun-induced erythema.
These examples confirm the value of the approach, particularly in situations where corticosteroids are a problem.
Available formulations of boswellic acids
As François Motte explains, the formulation drives clinical effectiveness: the boswellic acid molecule is bulky, hard to absorb and hard to drive into the skin. Suitable formulations therefore had to be developed, for topical use as much as for the oral route.
For Dr Guiot, this choice is also a lever for adherence: some patients accept a handy stick or a “kids” cream more readily than a standard tube. Practitioners therefore gain by matching the formulation to the patient and the context.
FormMain indicationsStrengthsNotesCreamAtopic, nummular and seborrhoeic eczemaEasy to use, anti-inflammatory action2×/day on clean, dry skin“Crelo” (fluid lotion)Hair-bearing areas (scalp, chest)Good penetration, non-greasy2×/dayStickLips, perioral area, cheilitis, angular cheilitisHandy, targeted formatCombine with a moisturiserKids versionPaediatric atopic eczemaEncourages parental adherenceSame composition as the creamOral liposomal formExtensive, relapsing eczemaImproves bioavailability2×/day 350 mg; avoid during pregnancy
Standard protocols worth keeping in mind
During the webinar, Dr Guiot shares several simple regimens that can serve as practical reference points. These protocols do not replace individualised treatment, but they give a clear base for adapting care to the type of eczema in front of you.
Clinical situationTopicalOralRecommended durationLocalised eczema (child or adult)Cream 2×/day–7 to 14 days, then reassessSeborrhoeic eczema (face/scalp)Cream or crelo 2×/day–10 to 14 daysExtensive flare (adult)Cream 2×/day2×/day 350 mgLoading phase possible (4/day for 7 days), then maintenanceSensitive areas (face, genital)Cream 2×/day–Close monitoring
Limits and precautions
Dr Guiot is insistent: there is no point “selling a dream”. Boswellic acid is effective, but not in every form of eczema.
In severe pompholyx (hands, feet), results are often insufficient, so potent corticosteroids do remain essential at times.
Where there is secondary infection (impetiginisation, herpes), anti-infective treatment stays the priority.
A few rare cases of contact allergy do occur, most often linked to the excipients.
Routine reassessment at 7 to 14 days therefore remains essential in order to adapt the protocol.
Treating eczema without cortisone: a solid alternative
Boswellic acids from Boswellia serrata now represent a solid therapeutic option for patients with eczema. They combine anti-inflammatory and antiallergic action, excellent tolerability, and a flexibility of formulation that makes it possible to treat children, adults and sensitive areas.
As François Motte and Dr Françoise Guiot pointed out during the Simplycure webinar, the aim is not to replace corticosteroids across the board, but to widen the therapeutic arsenal with an option that is safe, effective and accepted by patients.
At Simplycure, we support you in bringing these protocols into your daily practice and structuring your recommendations. Create an account or get in touch to find out more!
