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More Ingredients Doesn’t Mean Better Treatment: Why Combination Creams Are Not a Cure-All

A Dermatologist’s Perspective and a Traditional Chinese Medicine Practitioner’s Clinical Reflection

Originally written by Dr. Wu Wei-Hsin, Dermatology Specialist (Taiwan)
Translated into English and shared by Szenan Phua, Registered Acupuncturist (NZ) & Traditional Chinese Medicine Practitioner

Why Do Some Skin Conditions Keep Coming Back?

In daily life, many people experience itchy skin, redness, rashes, or irritation. When this happens, it is common to visit a pharmacy and purchase a “one-cream-for-everything” ointment, applying it repeatedly for months or even years.

What many people do not realize is that this habit can come at a significant cost to the health of their skin.

What Is a Combination Cream?

Looking at the ingredient list of the cream shown in the photo, we can see that it is a typical three-in-one combination cream containing:

1. Clotrimazole (Antifungal Agent)

Used to treat fungal infections such as athlete’s foot and jock itch.

2. Betamethasone (Corticosteroid)

Reduces inflammation, suppresses immune responses, and relieves itching.

3. Gentamicin (Antibiotic)

Used to treat bacterial infections.

At first glance, this sounds ideal.

Fungal infection? Covered.

Bacterial infection? Covered.

Inflammation and itching? Covered.

It seems like the ultimate skin cream.

Unfortunately, this is a misconception.

Mixing Everything Together Doesn’t Create a Michelin-Star Dish

Imagine preparing a meal.

Good cooking requires selecting the right ingredients and applying the correct seasoning for the specific dish.

If someone simply throws sugar, salt, vinegar, and chili sauce into every meal regardless of the recipe, would the result be gourmet cuisine—or an inedible mess?

Medicine works the same way.

Proper treatment requires an accurate diagnosis followed by targeted therapy.

A Typical Example: Jock Itch (Tinea Cruris)

The patient shown in this case originally had a fungal infection of the inner thigh, commonly known as jock itch.

For uncomplicated fungal infections, a properly prescribed antifungal medication alone is usually sufficient.

However, after applying a combination cream containing a potent steroid, problems began to develop.

The Short-Term Illusion

The steroid rapidly suppresses inflammation.

The redness improves.

The itching decreases.

The patient feels better.

The Long-Term Disaster

At the same time, the steroid suppresses the skin’s local immune defenses.

It is like removing all the security guards from a building.

The fungus has not actually been eliminated.

Instead, it is given an opportunity to multiply and spread beneath the surface.

When Jock Itch Becomes “Tinea Incognito”

This patient had been purchasing and applying the combination cream without medical supervision for approximately two years.

Because the steroid continually masked the infection, the typical appearance of the fungal disease became distorted and hidden.

This condition is known as Tinea Incognito (steroid-modified fungal infection).

The skin can eventually develop the appearance shown in the photograph.

Uncontrolled Fungal Spread

The infection becomes larger, more chronic, and more difficult to eradicate.

Skin Thinning and Dilated Blood Vessels

Long-term steroid exposure causes:

  • Skin atrophy (thinning)
  • Stretch-mark-like changes
  • Prominent superficial blood vessels
  • Persistent redness
  • Chronic post-inflammatory pigmentation

The original fungal infection becomes disguised, making diagnosis and treatment significantly more challenging.

Advice from Dermatologist Dr. Wu Wei-Hsin

1. See a Doctor for Disease, Leave Seasoning to Chefs

If you have a skin problem, seek assessment from a qualified dermatologist.

Accurate diagnosis followed by targeted treatment is usually the fastest route to recovery.

2. Combination Creams Are Temporary Tools, Not Long-Term Solutions

Combination creams may occasionally be prescribed by physicians for short periods when symptoms are mixed or diagnosis is still being clarified.

They are generally intended for days or weeks—not years of continuous use.

3. Do Not Self-Diagnose

Although pharmacy medications are easily accessible, inappropriate treatment may worsen the underlying condition rather than cure it.

An Important Reminder for Non-Dermatology Practitioners

When treating fungal skin infections, appropriate antifungal therapy must be continued consistently.

A steroid-containing combination cream cannot cure a fungal infection.

Consider this:

If a patient presents with headaches, cough, vomiting, or diarrhea, would you prescribe every patient the same cocktail of antibiotics, antifungals, and steroids regardless of the diagnosis?

Of course not.

Skin diseases deserve the same diagnostic precision.

The correct treatment depends on identifying the actual cause—not simply suppressing symptoms.

Key Takeaway

The best medicine is not the one with the most ingredients.

The best medicine is the one that accurately matches the diagnosis.

My Perspective as a Traditional Chinese Medicine Practitioner

After reading Dr. Wu Wei-Hsin’s article, I strongly agree with one of the most important messages he emphasized:

There is no single medication that can treat every skin condition.

Although Dr. Wu approaches this topic from the perspective of modern dermatology, I believe the underlying principle is exactly the same in Traditional Chinese Medicine (TCM).

In TCM, we have a saying:

“Treating only the skin without understanding the body is not true medicine.”

Many chronic skin conditions appear similar on the surface.

Patients may present with:

  • Redness
  • Itching
  • Rashes
  • Scaling
  • Oozing lesions

However, from a TCM perspective, the underlying causes may be completely different.

One patient may suffer from Damp-Heat.

Another may have Spleen Qi Deficiency.

Another may be experiencing Blood Deficiency with Wind-Dryness.

Others may be affected by chronic stress leading to Liver Qi Stagnation and Heat.

Although the skin symptoms appear similar, the root causes are often very different.

This is why TCM emphasizes individualized treatment rather than a one-size-fits-all approach.

What I Commonly See in Clinical Practice

Over the years, I have treated many patients with chronic skin conditions, including:

  • Eczema
  • Psoriasis
  • Seborrheic dermatitis
  • Chronic inflammatory skin disorders
  • Recurrent fungal infections

A common pattern I often observe is that many patients have used the same cream repeatedly for months or even years.

Sometimes the symptoms improve temporarily.

However, once the medication is stopped, the condition returns.

In some cases, the affected area gradually becomes larger, more sensitive, or more difficult to manage.

This does not necessarily mean the skin condition itself is becoming more aggressive.

Often, it means that the underlying imbalance has never been properly addressed.

Looking Beyond the Skin

In TCM, the skin is often viewed as a reflection of the body’s internal health.

When evaluating a patient, I am interested not only in the appearance of the skin, but also in questions such as:

  • How is their digestion?
  • How is their sleep?
  • Are they under chronic stress?
  • How are their bowel movements?
  • What are their dietary habits?
  • Are there signs of internal Dampness, Heat, Blood Deficiency, or Qi Stagnation?

Many chronic skin conditions are not merely skin problems.

They may be manifestations of deeper systemic imbalances involving the Spleen, Stomach, Liver, Lung, Blood, and Qi.

By addressing these underlying factors, we often see more sustainable improvements than simply suppressing symptoms alone.

Where Western Medicine and TCM Agree

Many people assume that Western Medicine and Traditional Chinese Medicine hold opposing views.

However, in this case, I believe both systems are pointing toward the same fundamental principle:

Accurate diagnosis should always come before treatment.

Dr. Wu reminds us that not every rash should be treated with a steroid-containing combination cream.

Similarly, in TCM, not every itchy skin condition should receive the same herbal formula.

The goal is not to find the strongest medicine.

The goal is to find the most appropriate treatment for the individual patient.

That is the essence of good medicine.

Final Thoughts

Whether viewed through the lens of Dermatology or Traditional Chinese Medicine, the message remains the same:

Medicine is not about finding a universal remedy.

Medicine is about understanding the patient in front of you.

When diagnosis is accurate, treatment becomes clear.

When treatment matches the true cause of disease, healing becomes possible.

Szenan Phua
Registered Acupuncturist (NZ)
Traditional Chinese Medicine Practitioner
Centre of Balance Acupuncture & Chinese Medicine Clinic
Hamilton, New Zealand

📞 0800 221 224
📞 +64 7 846 7956
🌐  Centre of Balance Acupuncture & Chinese Medicine Clinic

This article incorporates the original educational article by Dr. Wu Wei-Hsin, Dermatology Specialist (Taiwan), together with clinical reflections from the perspective of Traditional Chinese Medicine.

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Monica

I am originally from Hebei province in China. I hold a NZ bachelor’s degree of health and science with a major in acupuncture. I am honoured to be an acupuncturist at Centre of Balance. Helping patients to alleviate their pain brings me the greatest joy. Chinese medicine emphasises the unity of human beings and nature. During the treatment, I hope to not only relieve your pain but also help you to understand the principles behind acupuncture’s effectiveness, as well as the significant impact of diet, emotions, lifestyle habits, and living environments on disease recovery. Self-healing is an ability that our bodies are naturally endowed with.

I studied acupuncture in New Zealand and completed one and a half years of supervised clinical internship before graduating. In the early stage of my training, I mainly worked with patients experiencing neck, shoulder, and lower back pain. Under the guidance of senior clinical tutors, I gradually developed hands-on experience and confidence in treating musculoskeletal pain conditions.
As my clinical exposure expanded, I began treating a wider range of internal conditions. Alongside traditional acupuncture, I was introduced to Umbilical Acupuncture and Tungs-acupuncture Points. What interested me most about these approaches is that they often do not require needling directly at the painful area, yet can still achieve very effective results.
I was especially inspired by observing my supervisor use Umbilical Acupuncture to treat common conditions such as insomnia, menstrual irregularities, and even rheumatoid arthritis, with very positive outcomes. Another supervisor was highly skilled in Tungs-acupuncture Points and achieved excellent results in treating pain, infertility, menstrual disorders, and a variety of women’s health conditions. After completing my studies and entering clinical practice, once I observed Dr. Szenan Phua using Tungs-acupuncture points to help cancer patients relieve pain, which further strengthened my trust in this treatment method.
I later completed training in Dr. Tan Balance Acupuncture, which had a strong influence on the way I approach treatment. One of the most noticeable features of this method is how quickly patients often feel improvement, especially with pain conditions. Dr. Szenan Phua’s New Balance Acupuncture combines meridian regulation with structural adjustment and internal organ balancing, including techniques such as pulse balancing and spinal adjustment.
From my clinical experience, pain is rarely just a local issue. It often involves underlying organ weakness or structural imbalance. When these aspects are addressed together, treatment can be more thorough and longer-lasting. I also apply this approach to internal conditions, particularly in fertility and women’s health. This includes supporting natural conception, IVF preparation and embryo transfer, pregnancy support, early-pregnancy nausea, and late-pregnancy labour induction. I combine these treatments with concepts learned from a few additional fertility training, which has given me a broader and more flexible clinical perspective. This has reinforced my belief that acupuncture should be adapted to each individual rather than applied through fixed formulas.
Two other areas of study that have been very helpful in my clinical work are Tongue Diagnosis and Dr. Zhu’s Scalp Acupuncture. Although tongue diagnosis is taught in my standard Chinese medicine training, further study allowed me to deepen and refine my diagnostic skills.
My first formal training was in Li’s Tongue Diagnosis, which looks not only at organ patterns, but also at how different areas of the tongue reflect the body’s structure. This system also explores personality traits and changes during pregnancy, making it both clinically useful and engaging. I later attended online lectures on Yin’s Tongue Diagnosis and studied the related materials independently. this learning has helped me make clearer and more accurate pattern differentiation, allowing my acupuncture treatments to be more targeted. It covers a wide range of conditions, including skin disorders, oncology-related presentations, mental health patterns, and joint or limb problems. In practice, tongue observation often provides valuable insight even before a patient begins describing their symptoms.
In addition to the methods above, I regularly use local bloodletting techniques, which can be very effective for improving circulation, reducing swelling, and relieving pain. I also incorporate auricular (ear) acupressure and stimulation, which I commonly use for allergies, insomnia, headaches, stress management, and various internal conditions.
In my clinical work, I value taking the time to listen carefully to each patient and to understand their overall health, lifestyle, and concerns. Based on each individual’s condition, I also provide personalised dietary guidance and lifestyle or wellness advice to support overall health and long-term wellbeing. I commonly support patients with musculoskeletal pain, such as neck, shoulder, knee, and back pain, as well as stress-related conditions, sleep issues, migraines, digestive concerns, and women’s health and fertility-related conditions.