AIBU to think 1% hydrocortisone is high dose for six month old to start with?

[Peterbishopssarcasticsmile]

DS has terrible eczema on his face, neck and in creases of arms/elbows. It's flared up terribly in the last week and we had a telephone consult with gp - with pictures - and he was prescribed hydrocortisone cream. It seemed to work at first, it healed up the blistered areas really quickly, but now it's flared up to the worst it's ever been. It's blotchy and red and raw and scaly in places.
I've just realised after reading online that most people get 0.5% for babies - especially on their face - and I've been using 2%
We've now got a 1% hydrocortisone and 2% fusidic acid cream because gp thinks it's infected, but I've used it twice and it's made it redder than before and DS has screamed the whole time I applied it and for an hour afterwards
I'm tearing my hair out, I don't know what to do for the best. Could the 1% be too strong and have caused this awful flare up? I feel terrible that something I've put on him could have done it

[marly11]

Having had a son who had terrible eczema eventually treated at GOS, I would suggest it is fine though the medics in here may have more to say on this. In my experience once eczema has a 'strong' hold on the system it is difficult to shake it off, so faffing around with a really low dose of steroid won't stop it in its tracks. My DC is now an adult and still has to manage his eczema but nothing like the terror of it in his early years. What I did find, for what it's worth, is that GPs rarely know loads about eczema when it is really bad. So if you think your DC is really being battered by it all over his body I would try to get a referral to a good dermatologist or go privately to one you have researched so that you can get it managed as early as possible. Some babies grow out of it but allergies were on both sides of our families so my poor Ds didn't have a chance of escaping I guess. Also, if it's not been said to you, don't use softener in your washing and we were recommended using Persil non bio powder which we continue to use now. Definitely no bubble bath and GP might give you an emollient for washing in. Cotton comfort are a good company to look for all cotton clothing including great mitten pyjamas/babygrows and cotton gloves to minimise the effect of scratching. I hope he gets better quickly.

[Adoptthisdogornot]

1% sounds good to me. We had this terribly with 2 of mine. We ended up with a really strong steroid, Dermovate (clobetasol propionate) for the body. Better to nail it with a stronger steroid and then give the wee one a break and a chance to heal until the next flare up, than faff around not quite getting rid of it and getting into a never ending cycle. Triggers for my kids include cats (dander?) some pollens but most significantly, washing powder, even regular non bios and sensitive ones. We use skinnies laundry detergent for the whole family, it makes a huge difference. I can't recommend silk gloves for them highly enough, (they're called scratch sleeves I think?) for when your baby scratches in their sleep. Seriously, get some if you haven't already.
Keep going to the doctor, keep trying new emollients until you find the best for your child, they're all different in what they respond well too. We get through huge tubs of Zeroderm ointment, and also found Dermol 500 lotion good. Isomol comes highly recommended but wasn't great for us.
My heart goes out to you it's an absolute nightmare, but mine have mostly grown out of it, and it will get better eventually. Keep going back to the gp when you need to, don't feel like you're a bother. Also, in our experience, senior nurses generally knew more and were more helpful. Don't be afraid to ask for a referral. It takes a long time to get one, so the earlier you push for it, the sooner you'll get in front of a dermatologist.

[Adoptthisdogornot]

Oh yeah, also with one of mine, it was frequently infected. We discovered this when he was on oral antibiotics for something else, ear infections maybe? and his skin always improved dramatically when he was on them. This wasn't something the doctors ever flagged up as a possibility or looked to treat, so keep an eye out for that and ask if it's possible the rash itself is actually infected, I think it's hard to tell. The fusidic acid didn't really help unless applied straight away on places where the skin fully breaks, like under their earlobes. Oh God, I'm getting awful flash backs! Good luck. It's so hard, and everyone and their dog has a helpful suggestion which can be infuriating. The most annoying ones for me were "have you tried Aveeno?" "Have you thought about cutting out dairy?" Drove me bloody bonkers!!

[Peterbishopssarcasticsmile]

Thank you. So far it's on his neck in the folds both sides, under chin and around bottom of cheeks/mouth chin and up by sideburn area
He has bad cradle cap too which I'm slowly managing to get rid of and the dryness sort of comes down from there if you see what I mean
That's reassuring, I was worried about using the steroid cream on his face but that's where it's worse

Do you know how long it takes to see an improvement?

We have changed washing powder recently prior to the flare up changed from fairy non bio to surcare which was recommended by a doctor as being gentler... But perhaps it's not?

Should I be putting emollient on in-between the applications of fusidic? I have been so far today although it still looks livid and red and he hates having anything applied to it

[Peterbishopssarcasticsmile]

That question should be if the hydrocortisone and fusidic is going to make a difference do you know roughly how long it will take? Doctor said to use it for a few weeks but chemist said to use it for one week only especially around neck and face

[Penguinandduck]

My baby has awful eczema on her face and body too, which gets weepy and crusty and bleeds when it is at its worst. We’re fairly sure it’s allergy related as it’s in the family and she gets obvious flare-ups with some foods. The GP gave us 0.5% hydrocortisone, saying use for a week, then have 2 weeks without it before using again. I pushed for a referral to the allergy unit, and had a video appointment with the consultant last week - he said 0.5% is so low a dose that it’s almost homeopathic, and there’s no point using it for a severe flare up at all. He wants us to use 1%, 5 days on and 5 days off; he said he’d be more worried about the effect of using paracetamol or multivitamins daily than he would about using this dosing level of hydrocortisone, even if it continues constantly until she’s 5 years old. We also have a plan to try to identify what the triggers are, which is the hardest part I think, plus all the creams slathered on 5-6 times a day of course. Good luck!

[Councilworker]

If he has cradle cap then potentially he could have fungal growth which flares the eczema.
I have sebhoerric eczema on my face and ears which is basically cradle cap for grown ups.
How are you managing the cradle cap? Just with shampoo and oil or have you been prescribed anything. Ketoconazole shampoo can be prescribed for babies and there is evidence that it is effective to clear cradle cap. Anecdotally my gp suggested that when washing my hair with it I let it run across my face and ears. Especially my eyebrows. It made a huge difference and I no longer get the massive flares ups or need to use steroids on my face.

[Penguinandduck]

I guess the fusidic acid/hydrocortisone is just twice a day? If so I’d def use emollient in between - I plaster it on at every nappy change and top up on her face more often than that. If the cream you are using is making him more sore then try a different one. I’ve always seen an improvement after using hydrocortisone for 3-5days, though it doesn’t go completely.

[2020nymph]

Please, please, please be wary of using steroids, there is a condition called topical steroid withdrawal (TSW) where the body need higher and higher doses to treat the prescribed condition.

nationaleczema.org/warnings-for-topical-steroids-eczema/

I've seen first hand the effects of this.

[Councilworker]

Here is some info from the Eczema Society about cradle cap in infants and how it presents on the face

[Councilworker]

nationaleczema.org/eczema/children/seborrheic-dermatitis/

[2020nymph]

Please read Louise King's story

balmonds.co.uk/blogs/blog/my-topical-steroid-story-louise-king

[sayanythingelse]

Can you ask about a referral to the hospital? We saw an Eczema Nurse at our local hospital and she was a godsend. She had DD's eczema cleared up in a couple of visits. Now we use Betnovate and Elocon ointment if it flares up.

I'll attach a photo I took in the hospital because it really helped me to understand the creams and worry less about the potency that I was putting on my child.

[Penguinandduck]

It really is horrible - my eldest had it worse then current baby, and people used to stop me in shops to ask “what’s wrong with his face?” - it was heartbreaking. But it had cleared up loads by 18 months-2 years, and now he just has “normal” eczema occasionally (though has food allergies, asthma and hay fever to deal with).

[fluffydinosaur]

seconding what others have said, I dont think the dosage sounds too high. from what I understand severe eczema is more likely to respond to short ish treatments using stronger steroids rather than longer courses of weak ones. just to add, it might also be the heat that is causing it to be worse right now. my almost one year old has had eczema since he was 5 months old and although it has gradually improved over the last couple of months, it flares right back up again when the weather is like this or when he is teething. we've found that bathing his face in cool water with some oats added can soothe a bit. (you can also tie the oats up in a piece of muslin and use this to dab his face). also if he is scratching a lot it may he infected (or become infected) - we've had daktakort for fungal infections and antibiotics for bacterial. using an anti microbial emollient in the bath like dermol 600 can help reduce likelihood of infection - this can be prescribed by gp and since we've used it have noticed fewer infections. best of luck - it is horrible! hope you both have a good night

[ChangedAgainJune]

I feel for you, OP, as both my DCs suffered from this from about 4 months to about 2.5-3 years. I suspect immunisation had something to do with it, as there is no eczema in the family and it went away at the same age for both DC, having started after first round of imms. Both my DCs were tested for allergies, first was found to be allergic to milk and eggs- which I doubt was true, because elimination diet did not help one bit and now she can eat eggs and milk with no problems. Second DC did not test allergic for anything, yet, suffered same as older DC.
Tried all lotions, potions and natural remedies, but always came back to 1% hydrocortisone, when things worsened. It is hard, but just keep going and try different lotions. Porridge bath used to help: put handful of oats in a piece of cloth (making it like a teabag) and put in to bath. Calendula cream, Aveeno line used to be helpful, but nothing was strong enough to solve the problem. Hydrocortisone used to be the last resort when things would become unmanageable.
Both DCs grew out of it by the age of 3.

[Peterbishopssarcasticsmile]

Thanks so much for your messages. Could I create a kind of mini oat bath to dab gently on his face when it's bothering him do you think?

Feels like we have a long road ahead potentially :-/

[WaterOffADucksCrack]

My son's GP is an excema specialist is an eczema specialist and she said she would bath a newborn in steroid cream! I used it twice a day when flaring up. Plus epaderm 4 times a day even with no flare ups. Every day without fail.

[WaterOffADucksCrack]

Could I create a kind of mini oat bath to dab gently on his face when it's bothering him do you think? You can of course and it won't do any harm but ensure you do as directed by the doctor. An emollient would probably be best.

[Mypathtriedtokillme]

1 & 2% was prescription that actually got on top dd2’s eczema.
That and dermese which it mostly just white paraffin.

[NamechangeOnceMore]

In the nicest possible way, I think you need to trust your doctors. I can't give medical advice, as I've not seen your child, but as a GP I prescribe 1% hydrocortisone frequently, including for young children. If you're worried, why not speak to your GP again and explain your concerns so they can hopefully reassure you?

[Spandang]

Oh lovely it is horrible. I second being conscious of steroid withdrawal.

We found that wherever we put the steroids would clear up but then it would spring up somewhere completely new, and lots of little patches suddenly form one big patch.

I do think there are underlying triggers That cause or aggravate inflammation or the immune system. I found that once we had a diagnosis of food allergies (cow’s milk) and other allergies (tree pollen, sodium laureth sulphate and damp/mould) it reduced really naturally over time and without steroids.

It may be worth keeping a diary for a few weeks and seeing if there’s a patten of things that make it worse.

[geekone]

My DS was the same, his eczema poisoned but we discovered that it was the aqueous cream that the steroid is in and so like e45 we started using emollient (sp?) instead and that cleared it up.

[Watwing]

I second the pp who said go and see a specialist dermatologist. Our GP was the skin specialist at the practice but just didn't have the knowledge and experience to help with DS. Saw the specialist and it was under control quickly and because they had been doing it forever and had seen it all their confidence was really reassuring as yes steroids can cause problems but the specialists will know the best ones for long term use for kids.

[VoldemortsKitten]

OP I feel for you my little boy was the same as a baby. Fucidin exacerbated his, it seemed too 'wet' for his skin. Oats definitely seemed to help.

I know every child is different, we were referred to a hospital dermatologist when he was a year old and she prescribed him a 1% steroid and Aveeno Cream (not Lotion) it's oat based, and applied several times a day really really helped to calm the skin down and keep it moisturised without being too 'wet' It can just be bought off the shelf in Boots and might be worth a go.

Also keep fingernails as short as possible to avoid scratching and infection

Definitely persist in getting a referral if it stays bad, it's so distressing for both of you