Eczema advice before I see GP

[FrillyMilly]

DD (3.5) is having a really bad eczema flare up. She was diagnosed with eczema when she was about 9 months. She is allergic to most sun creams, managed to get uvistat on prescription. She give her regular porridge baths and slather on double base twice a day. However when there is a flare up I don't know how to get it under control and it takes us weeks (at least) to get back to normal. Last time we went to Go he gave us aqueous cream which made her red raw, she was crying when I put it on and it's was only by chance I saw on here that I shouldn't be using it to moisturise.

So I'm going to make a GP appointment to discuss controlling the flare ups but given last time he gave us the aqueous cream I want to have a good idea of what I want before we go. Should we be using hydrocortisone cream? What about antihistamines? We use piriton but it doesn't really seem to make a difference. A big problem we have is her sleep being disturbed and scratching in the night. Is it worth asking about the tubifast tops and gloves? Are these available on prescription. I've also heard about wet wrapping so is it worth asking about this too?

I always come away from appointments feeling like I've been fobbed off. I hate seeing my poor DDs skin red raw and her exhausted. The other day she fell asleep after only being up for 3 hours, when it's all under control she doesn't have day time naps. Most of the knowledge I have about eczema has come from here not HCPs.

hi my ds (8 y/o) has eczema but not too bad most of the time. we have only just discovered that when he has had cheese it makes it worse. dont know why but it does. other dairy products do not seem to affect him though. we now monitor the amount of cheese he has. could there be anything like that causing your dd's flare ups? with our ds it doesnt happen after eating cheese once, its a sort build up. try keeping diary of what she eats and when the eczema flares up to see if there is anything that sticks out.

we use oilatum bath ointment (it makes the bath quite slippy though) and we also use the cream. we use the aqueous cram only when necessary and i also find johnson's natural lotion (the green tube/tub) helps a little too.

Lush Dream Cream is fabulous - Oilatum in the bath is a winner with us, too, and Eumovate for flare-ups.

Other things that worked for us; really gentle washing powder (I wash DS's clothes separately from family wash) all cotton clothes inc bedsheets, changing my own body-creams and handcreams as these seemed to trigger his skin, using allergen cleaners and polishes around the house.

DS is 5 now, was diagnosed when he was about the same age as your DD and he is loads better now.

we use e45 bath oil (seems oilier than oilatum)
dermol daily (pat on don't rub)
don't dress straight away (wipes cream off)
hydrocortisone when there are flare ups
no soaps
no fabric conditioner in washing
use washing liquid rather than powder
all cotton bedding and clothes
light cotton at night
piriton if really scratching

Yes, you should be prescribed a steroid for flare ups. My DD started on hydrocortisone and actually has something stronger now. We don't use it every day, but we could use this particular one once a day.

The other thing you should be doing is using the emollient 4 times a day instead of 2 and making sure you use plenty of it. If she is still itchy with doublebase then ask for a different one, there are quite a few you can try.

At DD's worst I found an omega3 supplement seemed to help a bit (I think there is some clinical evidence for this?). I also use Surcare for washing clothes and bedding and no fabric softener.

I think getting the eczema more under control in general would probably help with the night time scratching so it's probably worth focussing on this first before you try wet wrapping etc.

I had awful eczema as a child and into my teens. It was finally brought under control by a hoemeopath (who was also conventional gp).

Both my dc started eczema at 6 months (DD is only 7 months now!) and we have been through various moisturisers, oilatum etc from doctor. He won't prescribe hydrocortizone for v young children, especially where the eczema is so generalised as DD's.

I found the best moisturiser for both DCto be Burt's Bees Baby Body Lotion. Not cheap, but v effective.

Doesn't sound like your GP knows much about eczema if they prescribed aqueous cream. I would just go and say you want a referral to a consultant, they know much more about it and can advise on things like wet wrapping, allergy testing etc.

In the meantime yes, you need to use steroid creams on flare-ups. Hydrocortisone is a very weak steroid and absolutely fine to use every day. Piriton ime doesn't make any difference although some people find it helps their DC sleep.

Yes you can get tubifast/comfifast garments on prescription. My DD is nearly 4 and she really likes the mittens you can get and will now ask for them when she is having a bad itchy time. Wet wrapping and wrapping with other things would be unlikely to be prescibed by the GP IMO as they are generally not very knowledgable about eczema when it is chronic. You should ask for a referral on (NICE guidelines back this up) as the symptoms you describe would definitely warrant a referral to a consultant dermatologist (such disturbed sleep that affects the family is one). I would push for this if I was you. Or there may be specialist nurses in your area who see children with these sort of problems and they can be fantastic with loads of good advice/support.

You should be given a steroid to get the flare ups under control. An ointment rather than a cream is best too (i.e hydrocortisone ointment rather than cream - lots of GP's don't even know this).

I totally sympathise re the sleeping issue. We have found anti-histamines even the sedating ones of little help.

Have you asked for a different emollient such as Epaderm/Hydromol, these are very clarty but do keep the skin in a good condition. You need to use them many times a day when things are particularly bad as Apple said.

Good luck and do not settle for anything other than you feeling satisfied when you visit the GP. I can't believe you were fobbed of with aqueous cream, poor DD.

some good suggestions here, just adding the link to the NICE guideline - indications for referral. Disturbed sleep is one. Poor DD, aqueous cream drives my skin wild. It might also be an idea to have a chat with the Eczema Society free helpline before the GP appointment. They should be able to help you prepare for it.

Thanks for the advice everyone. I feel like my own lack of knowledge is making things worse. Surely after dealing with this for 3 years someone should take me seriously and we should be getting it under control. I didn't realise I should put the double base on so often. I asked about a different emollient but the GP told me they are all the same so no point.

I will ask for a referral to a dermatologist. They used to run eczema clinics but they stopped doing them around the time she was diagnosed so I never got to take her.

Sounds like you need a referral to a dermatologist. GPs are often useless when it comes to dealing with eczema in my experience and prescribing aqueous cream as an emollient is yet another example - the dermatologist told us aqueous cream should NEVER be used as an emollient only a soap substitute (and even then she wouldn't recommend it). A specialist will probably prescribe some steroid ointment initially to get the eczema under control and then you can start a good creaming routine to keep it at bay (up to 5 times a day). Sadly there will always be flare ups but knowing how to deal with them and 'nip them in the bud' really helps.