Eczema and I don't have a clue

[lookout]

Ds2 is 7mo and has eczema pretty much all over him. It has been controlled up til now with Epaderm, but the GP this week asked us to try Diprobase to minimise the risk of folliculitis. It seems to be working ok.

GP has been pretty unhelpful from the start really, so I don't really know if what we're doing is right or not. I suspected dairy from the start after ds had a flare up with milk after I'd had a spell without (he is breastfed), so have been dairy, egg and soya free now for nearly 8 weeks. I tried eggs last weekend and the poor mite had a flare up on his arms, so back off the eggs. Plan to try them again this weekend to double check, but I've no idea if that's the right thing to do or not. GP told me to stay dairy free til he's abit older, 9mo ish, then try him directly on dairy.

The poor thing itches as soon as we get his clothes off, and his head and neck all through the day, does this mean I need to moisturise more? And when exactly do we use the steroids? I was told not to use them for more than 3 days at a time, but one inflamed patch will die down with steroids within 3 days and another will flare up in another place (these patches are small, not big flare ups like we have had in the past), so I end up using for days on end in different parts of his body . Also when he does flare up, he sleeps atrociously, poor thing, as the itching wakes him.

I know it's pretty mild, I have seen much worse myself in other kids. I just don't have any idea if we're managing it correctly. Any advice gratefull received

you put the steroid cream on and then the diprobase over the top, using it on different areas of the body is fine, you just don't want to put it on the same patch of skin for more than 3 days

you can use an antihistamine (piriton) to help with the night time ichyness

also you might want to check you are using enough diprobase -pump a line onto your finger from palm to tip -this amount will do 1 leg

my DD's eczema isn't diet related so I've no advice for that one but if it's bad enough to be disturbing sleep then you can ask for a referral to a dermatologist

Hi Lookout

Your DS sounds like my DD who just seemed to be a very itchy thing from day 1. She is 4.5 years old now.

She would also (and still does but not as badly now) scratch herself raw as soon as we undressed her for a bath or nappy change.

Our GP, basically told us to keep her well moisturised, to stop her skin becoming too dry. He said we should moisturise as much as necessary. When she is bad we do 2 or 3 times a day, but most days it's just once a day now.

We have tried a few creams like double base, aveeno, cetraben and another one I can't remember the name of. We also wash her in aqueous cream or oilatum and cream her after her bath. Some nights if she is itchy in her sleep, I go and cream her again, and this seems to help. We're on Cetraben at the moment. Double base didn't do anything for her. She started to react to Aveeno, which I think was the best at keeping her moisturised. I smother her in Cetraben and rub it in until it disappears. Any less seems to be less effective.

Regarding the steroid cream, we were told to only use it when DD's skin seems red or sore/weepy looking. She's only really had 'typical' eczema in the creases behind her knees and on her wrists and on a patch on her bottom and side of one thigh. She is itchy all over though there isn't any visible eczema.

I spoke with DD's allergy nurse and she recommended that we should try Hydromol to wash DD with and an emolient called Balneum, which has an anti itch property.

If you find the Diprobase doesn't work, then go back to your GP and ask for something different.

Also, DD was taken off dairy at 8 months old and that made a massive difference to how much she itched. If you think that dairy and eggs are making a difference then maybe see if you can get your GP to refer you to have your DS tested for allergies. Esp as your at the stage where your weaning him. I think I heard somewhere that if children have eczema from a young age then that could be a sign of allergies or intolerance, so worth asking for a referral to an pediatric allergist.

Sorry for my very long post, but I hope this helps a little.

Take care

Oh and we have also used piriton in the past to help her get comfortable esp at night.

Hiya. We are having the same trouble with our DS 5 months. He is so itchy. Poor thing scratches himself so badly. Doesnt enjoy bath time or splash because he is so focused on scratching. We have been going to the GP for 3 months now and kept on being given emollients and steroids. This is not the answer. Eczema is so often triggered by food allergies. Especially cows milk protein, egg, gluten and citrus. I had to break down in tears at the doctor but have finally been referred to paediatric allergist who is now performing RAST blood tests. It is the only way to work out specific allergens. Without it I was doing what you are doing. Cutting foods out of my diet and when I fed him anything I held my breath and prayed for no bad reaction. This is impossible to keep up as there are so many possible causes. Get a RAST test at least it will give you some answers and tell you if he is or isn't allergic to specific things. Good luck

Hi again

If you do get referred to a pediatric allergist these are the sorts of tests they'll do.

The only thing to remember is that skin prick tests and RAST (blood tests) is that they test for the immediate response type allergies. It is possible to have allergies to all the things you mention, but as eczema is a delayed reaction, the results may come back showing no allergy.

I also think that you should ask to be referred though as KatFriz is right that there could well be a link with the problems your DS is having and allergies and it's worth getting it checked out. You are entitled to ask to be referred and if you ask your GP has to do it. If you're not sure where your nearest clinic is, then you could all the AllergyUK helpline, who would be able to advise you of your nearest clinic and that way you could ask your GP to be referred to that specific one.

Just so you know DD has LOADS of food allergies and these first started at 6.5 months when she had an anaphylactic reaction to the wheat in a baby rusk.

KatFriz, did your DS test positive for any allergies? Hope he's doing ok.

Thanks all so much for the replies.

We are doing exactly that wrt the creams etc, so that's a relief. Have not wanted to go down the piriton route yet, he's so small, but if it gets out of control again I will definitely consider it.

Will ask for a referral but the last time I mentioned it the GP didn't take me seriously at all. I might have to try the waterworks also if I get the brush off again.

Hello Lookout.Don't be fobbed off by the gp. If you can call the allergy UK helpline and ask for their advice.

I just found this on the internet. it's part of the NICE guidelines and might be helpful.

Good luck and remember as part of NHS Choices, you're allowed to ask for a referral and the GP should comply.

Hi lookout, I have had eczema since I was a baby and both my LO's have eczema, and they see a dermatologist and eczema specialist nurse so I hope I can be of some help.

mumat39 has given you a great link, the NICE guidelines which stands for the national institute of clinical excellence, all doctors are meant to follow these guidelines.
In these guidelines for eczema it clearly states that any baby who has eczema from a young age or who seems resistant to treatment should be suspected of cows milk protein allergy. You should be given neocate formula to start as early as possible because at some point ober the bext few years (or much sooner!) you will stop bf and you need to introduce these vile tasting formulas early so they accept them. Soya and egg are also very common allergens for eczema.

His skin may not lo

Sorry pressed post by accident, copied and pasted all again, sorry it's very long!

Hi lookout, I have had eczema since I was a baby and both my LO's have eczema, and they see a dermatologist and eczema specialist nurse so I hope I can be of some help.

mumat39 has given you a great link, the NICE guidelines which stands for the national institute of clinical excellence, all doctors are meant to follow these guidelines.
In these guidelines for eczema it clearly states that any baby who has eczema from a young age or who seems resistant to treatment should be suspected of cows milk protein allergy. You should be given neocate formula to start as early as possible because at some point ober the bext few years (or much sooner!) you will stop bf and you need to introduce these vile tasting formulas early so they accept them. Soya and egg are also very common allergens for eczema.

His skin may not look awful but if he is scratching all the time then it's bad. You should use a moderate strength steroid on all the usual areas of eczema, whether they are currently itchy or not, for 2 weeks. So something like synalar 1 in 4 cream would be ideal, or eumovate is ok too. On the face use hydrocortisone only. Epaderm cream is better than diprobase, diprobase or doublebase are very light emollients and can be itchy. Epaderm ointment for overnight or when very dry is good, but not all th time if possible.
When applying emollients apply in one direction only, downwards, and do not rub into the skin, allow the skin to absorb it naturally. Rubbing/massaging it in encourages the risk of follicullitis and actually makes the skin feel more itchy too.

Feature everyday for ten minutes maximum. Apply Dermol lotion all over including the face before getting in the bath. Add Dermol 600 or oilatum in the bath. If the scalp is itchy use a steroid gel and wash with alphosyl shampoo.

Definitely get a referral to an allergy specialist or a dermatologist with an interest in allergies. You can ask to be referred to any hospital or consultant of your choice. and don't take no for an answer! HTH.

Bath* not feature everyday!!! The reason for this is that when you have eczema you have broken skin so any bugs sitting on your skin are more likely to cause an infection compared to somebody who doesn't have eczema. But you limit the bath to 10 minutes to stop drying out the skin.

ChocaMum Wow, thanks so much for taking the time to post. Great info, very helpful. We've been given acqueous for cleansing in the bath, and oilatum to put in the bath. We are still using epaderm at night as it's way more effective, but during the day atm the diprobase is working far better than the cetraben did.

I had assumed that as I couldn't see anything eczema-like, even though he was itching, that it was mild. I dread any nappy change and bath time because he just claws at his skin. It looks worse from scratch marks more than the normal look of eczema that I know of, but it is obviously causing him distress as he is covered in scratches, in spite of me filing his nails every day .

I'm gonna make my way back to the GP on Monday and ask for a referral. I'm not entirely convinced about the allergy thing, but since he only seems to have big flare ups when I re-introduce certain foods, it seems to point that way. Would he be itching as much as he is even though my diet is completely dairy free if it was dairy as a trigger?

mumat39 thanks for the link. I must have been to the GP 4 times with this and never once have we been through any of these kinds of questions. What would be the best way to approach this if they try and fob me off again? I always seem to come across as the neurotic mother, rather than a rightly concerned one...

Emphasise that he is not sleeping so you're not sleeping and it's having a massive impact on your quality of life. Take in a copy of the eczema nice guidelines and say eczema not responding to treatment should be considered for specialist allergy referral.

Eczema has many food allergens so I think a detmatogist and allergy specialist would be really helpful. They have really helped my little two.

Aqueous cream contains soap and is very itchy and should neer be used on people with eczema, even just pre-bath. Dermol 500 lotion with Dermol 600 in the bath is the ideal bath combination.

My ds (4mo) has just had 6 weeks of wet wraps which has really helped too. But it is a hassle. May be worth considering though.

ChocaMum another reason why I mistrust GPs. It was the 3rd different one we've seen who prescribed acqueous for washing. I thought I'd read on here that it was not a good idea, so it's stayed unopened in the cupboard. Glad I didn't listen to him now. How are we supposed to go with confidence to these people when many of then don't have a specialised enoguh knowledge to help us safely??

Chocamum, i hadn't realised that about aqeous cream. I'll also try and get the dermol 500 & 600 that you've mentioned. Lookout, sorry for the bad advice re this.

I looked at a bottle of hydromol today and it made me chuckle. It mentioned a skin condition called ' itchyosis' which sounds like the sort of word my DD might come up with.

Re the Nice guidelines print them out and take them along with you and show the Gp the things that it mentions that you little one has. don't accept a referral to your local hospital unless you know they specialise in allergies. if you ask specifically for a referral to the clinic that you want yhe GP has to listen.

Eczema is annoying as it seems a constant management issue. i ran out of both aaueous cream and cetraben yesterday and washed dd is oilatum. her skin today is so dry and so itchy. I'd actually started wondering if it was improving but clearly it's just the effect of the emolient. Chocamum, do you know of any way to help moisturise the skin from within? I've read about virgin coconut oil being good.

Chocamum thanks again for the great advice cream
Lookout good luck with the gp. remember he has to do as you ask.

The only way to basically nourish the skin from within is to encourage new skin formation that does not have eczema in it. This is with creams called protopics which can only be started by a dermatologist. Both of mine are on it and it does work well. But there are concerns that if exposed to sun while the cream is being used that there is an increased risk of skin cancer. But with me and my little ones we always stay covered up in the sun because it aggravates our eczema.

For my eczema and dry skin I love body shop cocoa butter, lasts all day in me. But I just stick with the prescription ones for the two LO's.

Hydromol ointment and epaderm ointment ate practically the same thing by the way.

You can also buy all these I'd you've run out and need one in an emergency. If its normally on your prescription then keep the receipt and get a refund when you get your next prescription by letting the pharmacy replace the prescription bottle for the one you bought.

Also read labels of both prescription and shop bought creams etc because some contain arachis oil which is peanut oil, and research has shown by letting peanut traces in through eczema skin you can cause peanut allergies. Better to be more cautious just in case.

Just to add to ChocaMum's advice - GPs seem to give crap advice in general about eczema - eg only using steroid for 3 days, etc. My DD had eczema pretty much from birth, and it was only by seeing a dermatologist that we finally seem to have it under control. The steroid should be put on at least 30 mins before the emollient (we also found Epaderm really good). We were also told to put loads of emollient on, stroking in the direction of hair growth and not rubbing it in. Hope you get a referral and get it sorted. Also, the dermatologist told us about Dermasilk pyjamas which made a huge difference. They are very expensive, but some GPs are able to prescribe them on the NHS (ours wouldn't, so we bought them, but it was so worth the money).

All the advice is really good, I had eczema as a baby and both DS and DD had it when they were babies too. Oilatum in the bath, loads of diprobase whether or not they have patches ... it was pretty much our routine. The good news is that they've both been pretty free of it for a long time now, (they are 10 and 15) and that's the experience of several of my friends too. A lot of children do grow out of it.

Allergy tests are really important. I think the big moment for us came when we tried goats milk instead of cows when DD was about 4 and a half. The eczema count died away dramatically from then on. While they can both drink ordinary milk without an instant reaction nowadays, we do still steer clear of it.

Which is not great news for me, because goats milk is probably only food or drink item that I really, really hate, loathe, and generally run screaming from!!!! Sigh.

One other thing you might try as it worked for us, is to put two drops of lavender oil in their bath water. If you are using a baby bath (or the basin as we used to!) I might err on the side of one drop. This was something a friend told me about ... she gets eczema on the soles of her feet and found it cleared up quicker than the steroid cream. It certainly helped my two.

I forgot to go into the steroid treatment a bit more, so sorry to bore you again! Ideally you should start with a moderate strength steroid for the body that you apply to all usual eczema sites for two weeks once a day. Then stop. When you notice your dc itching or feel that the skin is bumpy and rough ( I hope you now what I mean, and I do this in the bath because I find the skin is easiest to feel for rough patches when it's wet) then start using the steroids, don't wait it to go red and obvious. You should then use the steroid to clear the patch but for at least a further two days. The reason for this is that your skin is in layers and if you stop as soon as the top visible layer is clear then you haven't treated the full thickness of the skin. A weeks treatment is quite common to clear a patch properly.
To know how much steroids to apply to any area, you look at the guides that describe it in fingertip units (FTU) where one FTU is one strip of steroid across your middle fingertip (not covering the whole fingertip in a circle but a strip from the very tip to the first crease.) Then it depends on the age of your dc. Both the eczema uk and patient.co.uk show guides for how much topical corticosteroid you should use.

www.eczema.org/Factsheet_Topical_Steroids.pdf

www.patient.co.uk/health/Topical-Steroids-for-Eczema.htm

The other thing to be aware if is dust mite, a very common trigger for eczema. The eczema nurse told us to wash all sheets and clothes at 60 degrees or above because otherwise the dustmite will not be killed. Soft toys for LO's are a big culprit so freezing them for 24 hrs kills the dust mite too (we do one toy at a time in the freezer each day, or I just wash them at 60 degrees and replace ones that eventually start to fall apart.) Obvuously cleaning room and dusting room and opening windows to get rid of as much dust mite as possible. Ideally blinds instead of curtains and no carpets too. Changing sheets frequently and washing at 60 degrees. Anti allergy whole mattress covers (we got ours from John Lewis and basically the mattress goes inside it so it's completely covered) and also anti allergy pillow covers and duvet covers.
Because pollens and animals are common triggers too, we were told to shower or bath them after they have been outside when there's a high pollen count or around animals.

I hope you are surviving my long posts! :)

www.patient.co.uk/health/Fingertip-Units-for-Topical-Steroids.htm

ChocaMum, you're brilliant and so much more helpful than any GP I've been to see re DD's eczema since she was born.

I didn't know about the not rubbing cream into the skin. DD's skin doesn't seem to absorb it so well unless I do this. Is there a trick to getting it in. I don't really run it in, but put it on on long strokes until its absorbed. Usually in a downwards motion.

Do you think Diprobase is better than Cetraben? I was really surprised that DD's skin was SO dry and itchy today after missing the cream just once.

Also, should we be asking to see a dermatologist? Or shoud the allergy clinic we go to be able to help? In the past, the allergist always looks at DD's skin and is surprised that he can't see any signs of eczema. I always tell him that she scratches constantly but he just always writes in his letter to teh GP that DD's eczema is in remission.

Sorry to bug you with so many questions.

Thanks again and hope you and your little ones are well.
xxx

Thanks mumat39. I think we have all had the frustration of useless health professionals so it's nice to be able to pass on useful information to others.

I think both cetraben and diprobase are first line light emollients so I would personally recommend going onto epaderm cream and emollient. If your gp seems relictant you can say they make your dd's skin red and you've read you can become allergic/intolerant to emollients at any time (which is true by the way!) Epaderm cream does take a good few minutes or more to be absorbed, but with little ones there's always so much to do while you're waiting for the cream to disappear! Actually the sun cream should be applied in the same way, left on in a white layer and left to disappear on its own rather than rubbed in.

I'm surprised and annoyed your allergy specialist doesn't take your dd's eczema more seriously. Where shouts in the uk are you? If you're in or near London, we see an amazing allergy consultant who is also a dermatologist called Helen Cox. Otherwise I do think you need to see a dermatologist if your allergy specialist is deluded and thinks your dd's eczema is in remission. I would also try using more steroids until the scratching is under control, and then I always tell our consultant how many tubes of steroids we have to use per month to control the scratching and that's how she assesses the severity of the eczema. Because I never let their skin get red if I can control it, when we go to the clinic their skin looks amazing! But she trusts me and treats accordingly. But she does tell me to avoid showing their skin to our GP because they probably wouldn't prescribe what she recommends to them if they saw how lovely their skin looked!

We are surviving, just about! Thanks for asking.

Thank you so so much for all the brilliant advice. Have bookmarked the thread so I can keep referring to it cos there's so much info - ChocaMum what a star! I am not only surviving but very grateful for your long posts!

We have only been prescribed 1% hydrocortisone but it does clear up the patches within a few days so I'm hesitant in trying anything stronger for now. Interesting you saying about using it for a few days after it seems to have cleared - several times I've stopped as soon as the redness has gone only to see it pop back up the next day. Will try your method next time.

The first GP I saw did tell me not to rub the cream in, so at least they've got one thing right so far .

I am terrible at housework and find it very difficult to keep ds2's room clean enough to be happy about it. I probably only dust and hoover in there once a week . I do open windows every time he's not napping, and change the sheets every two days (but that's because he dribbles so much on them when asleep and leaves greasy marks from the Epaderm!) Have removed soft toys from the cot, but will try freezing/washing them instead, in case he gets lonely without them

Just to clarify for my sleep deprived brain - should I be asking for a referral to a dermatologist or an allergy clinic?

ChocaMum those links are amazing too, thank you.

Hi Lookout you've had lots of good advice on this thread :)

You need a paediatric allergy specialist, they should know loads about eczema as well as being able to arrange allergy testing. We were referred at 4mo for DS1 and also spoke to a dietician who advised on the food exclusion.

Also bear in mind that food allergies can take months/years to fully manifest themselves. Milk used to bring DS1 out in hives but since 2yo he has been fine with it. He became allergic to sesame about a year ago (he's now 5yo) and last weekend reacted to peanuts for the first time. Blood testing is not an absolutely reliable marker but just another tool which the consultant will use to try to work out what's causing problems.

I'm not sure who to recommend you seeing I'm afraid because it depends on the doctor you see as to how useful they are. My experience is that our allergy specialist deals with everything with our dd and ds, but as mumat39 has said, her allergy specialist does not deal with the eczema at all. And I have found that frequently the case on the allergy board, we all have different experiences of different specialties.
I think maybe start with an allergy specialist so you can at least start on a hypoallergenic milk formula and do some testing to see if it's just cmp, eggs and soya of if there's any other allergies. And if necessary see a skin specialist after that.

From the hydrocortisone point of view, it's not really recommended to use it anywhere other than the face. The reason is that using weaker steroids doesn't get on topic the eczema enough, so you end up using a lot more of a weaker steroid compared to short bursts of a stronger one and then overal you run the danger of currently using more steroids than necessary. I hope that makes sense! :)