Alternatives to Betnovate etc

[EmmalinaC]

Hello.

DD2 aged 3 has severe eczema. We're currently using diprobase, a 1% hydrocortisone and Betnovate depending on the severity of the flare up.

I recently visited the GP to ask if there was any alternative to this regime and was given a lecture about not using the medicines correctly. She advised me that I needed to use the Betnovate for 2 weeks in order to bring it under control. The affected area is huge - front and back of legs, elbow creases, armpits and tummy - and although I know it will work on this occasion I'm really dubious about this as a long term treatment plan.

We already avoid product like shampoos, biological laundry liquids etc and the only other thing that seems to help is a good dose of summer sunshine (once the spring pollen is out the way!)

Does anyone have any suggestions for what else we can try? The GP won't refer us to a dermatologist because as far as she's concerned, the Betnovate works!

I'd also be interested to hear from anyone who has used Betnovate or similar for long periods -I'm am willing to be told I'm being pfb, if that is in fact the case!

Thanks

Our DS had severe eczema on his ankles and behind his knees. We wash all his clothes in non-fragranced gentle detergent and barely use soap on him - every few days we put a non-fragranced baby wash in the bath (he is now 6).

The only product which got rid of his eczema was Sudocrem. We still use it if he has a minor flare up after going swimming.

I agree sunshine helps and being extra cautious about drying those areas gently after baths etc.

Hope things improve soon. I don't know if there are truly hard and fast rules, because everyone is different and responds differently to treatments, you have to muddle your way through til you find what works for our own child.

My DS was (eventually) referred to a dermatology nurse and she was fantastic. The first thing she told me was that I would be horrified by how much steroid ointment she would be telling me to use as we have all been brainwashed into thinking that any steroid use is bad. She explained that the levels considered safe are in fact much higher than most of us (including many GPs) realise but of course they do have to be used carefully. We use Eumovate regularly on DS as it is the only way to get and keep his eczema under control (apart from his face where we use hydrocortisone 1%). The nurse told us that you should use one fingertip full (ie a line of ointment from end of finger to first crease) for one hand's worth of skin if that makes sense. So, for our DS (nearly 6), we would normally need 3 fingertips of Eumovate for his entire back area (roughly the size of 3 of my hands) if the whole are was affected. You have to keep using the strong steroid for at least 4 days after the eczema appears to have cleared up as the lower layers of skin will not yet have healed and if you stop, the eczema will flare up again straight away so your GP is right in saying you need to use the Betnovate for 2 weeks in order to fully clear up a bad eczema flare (although maybe you could ask if Eumovate might be sufficient rather than Betnovate as it's slightly less potent). The other thing she said was not to just stop the potent steroid (Eumovate/Betnovate etc) but to gradually reduce the amount you use and then swap down to hydrocortisone before stopping entirely as this can help avoid the 'bounce back' effect. In fact, in DS's case she decided that we should use Eumovate at least once a week even when his skin seemed fine as a preventative measure and this works well for us and actually reduces the number and severity of flare ups. Also, unless your DD has wet eczema, the steroid should be ointment not cream as this is far better for dry skin conditions. We were told to apply the steroid at least 20mins before the emollient to give it time to absorb. What do use in the bath? We use Dermol 600 in the water and Dermol 500 as a soap substitute (we don't use any shampoo). One more piece of advice from the nurse was to permanently turn off the radiator in his bedroom, even in the winter, and put a cup of water on a shelf in the room to make sure the air doesn't dry out.

My friend who is a paediatric dermatologist says exactly the same as your GP and Freefrommum's dermatology nurst. My dd was covered pretty much head to toe in very severe eczema after an allergic reaction and I spoke to my friend about how best to treat it. She said that it was completely fine to put betnevate all over my dd's body for initially a week, then a further week if it wasn't under control. Then the following week step the steroid cream down, e.g. if using betnovate initially, use betnovate RD the next. Then the following week, step it down again, to 1% hydrocortisone. She said it's much better to use high strength steroid cream for a relatively short period of time (short = a couple of weeks) than lower strength cream (e.g. 1% hydrocortisone) for longer periods of time.

Sorry, should also have said, that once the flare up is under control, you then use moisturiser obsessively to ensure it doesn't come back.

Totally agree with neolara. I too forgot to mention using emollient/moisturiser as much as possible. When DS was little we used to apply emollient 5 times a day. It wasn't easy but was definitely worth it. We now apply twice a day every day, sometimes 3 when his eczema's bad.

I'm 48, and have been using Betnovate my whole life. That sounds like an AA confession! I use a really dilute one most of the time now, and save the "strong stuff" for the very odd flare up when I have come into contact with a trigger - like sleeping on bedlinen washed in smelly powder.

Keeping to non-bio on it's own isn't enough for me, it might be worth trying a few different ones, to see if that makes a difference. I can handle Fairy, and that's about it - not even liqui tabs, just tablets. Mainly I use Eco Balls now, which means no chemicals at all.

A GP recently told me that it was OK to use as strong as you need when you have an outbreak, so long as you stop as soon as it is clear. Otherwise the skin develops a tolerance and you just need to keep piling it on.

The only long term problem for me is that I have very thin, sensitive skin. I burn very easily, and have the hands of a 100 year old. That said, I'd rather that than the pain I used to be in with split skin!

Moisturise, moisturise, moisturise. Don't believe that just because something works for one person it will suit your DD. eg E45 is no good to me, but Diprobase is great. Epaderm brilliant for me too, when really bad, but a bit messy. On my face, I now use a mixture of Aloe Vera gel, and then Weleda Almond oil. That has been a revelation, and I wish I'd discovered it years ago.

my ex h used Betnovate and has quite bad thinning of the skin where he over used it - but I am talking years and year and years of overuse.

I would definitely use it if it works - I have used it before too and it is a lifesaver - but just beware of the long term use (and I mean very long term use)

If at her age you're having to regularly use betnovate, I would ask for a referral. There are also lesser creams than Betnovate but stronger ones than HC1% that might be worth trying!

Thanks so much for all the replies - reassuring to know that the advice we've been given is the best way forward.

We're 8 days in to the Betnovate regime and DD's eczema has cleared up completely. Will continue to apply for another day or so and then switch to 1% hc until the two weeks is up.