Advice please on use of steroid creams on 6 month old with eczema

[rainbowweaver]

My son developed seems at 3 months old. We've applied steroid creams (hydrocortisone 0.5%) twice before, the first twice daily for 5 days then once daily for 5 days; the 2nd once daily for 5 days. The eczema subsides while cream is used but comes back with a vengeance after. Are we doing wrong? How do you apply the cream and for what duration each time? Also, eczema is on his face and neck. Many thanks for any insight!

My son had bad eczema as a baby and was referred to dermatology by another hospital consultant when they saw him for something completely different (I.e. not the GP) . They recommended wet dressings and gave us lots of different emollients to try but the main thing we found made a difference was the advice to use as high a strength steroid as needed to clear the patches then trying to keep them away with the emollients. I tried everything re allergies but couldn't find a trigger. Son is 13 now and still uses emollients but never gets eczema now.

Just read your earlier post about kin weeping and we had special paint to put on any broken skin to try and prevent infection - cant remember what but I know they were really concerned about possibility of infection. Also baths were not advised as too drying out for skin so only had a bath once a week or so.

Never tried Apple Cider vinegar but the E45 bath oil found far better than Oilatum. I think that all of the moisturising/cutting out conditioner/limiting baths etc is a help but if there's a flare up of moderate eczema proper steroid or other dermatologist prescribed treatment really is needed. My gp said that I could have done all of that type of stuff I wanted but DS's eczema would never have cleared up with that alone.

Don't think we ever needed it for that long, but we did have some stronger stuff than hydrocortisone, so we must have tried hc for a week, seen no improvement and gone back to the gp. If its coming back the moment you stop applying, its not clearing it properly. Go and explain all to the gp , and when you've found one who understands eczema, stick with them.

many many thanks! Will persevere with this hc treatment for 14 days, and book a gp appointment for the end of the 14 days if no joy.

We used the steroids for over a month, when it didn't clear up that was what prompted the gp to try the Protopic. It sounds as if your son is very similar to my ds, the steroids stopped the really bad skin cracking but never really cleared it up or kept it at bay.

The reason you're meant to separate the emollient and steroid when applying is that the emollient can dilute the steroids. You may find you need a stronger steroid as it's better to use a stronger one for a shorter length of time according to our dermatologist. And yes, aqueous is a soap substitute not a moisturiser.

Our GP was hopeless, just told us to moisturise. DS's eczema didn't clear up until we saw a dermatologist.

Agree, if not clearing the eczema within the 5 days it suggests you need stronger steroid. We found it transformed treatment applying higher dose for short time, 14 days is too long to try and 0.5% is comparatively weak. Can't quite remember what we used but definitely 1% and 2.5%.

We went to big London hospital recently, and their best practice on eczema:

Use an emollient thick enough to write your name in. Apply in the direction of hair growth, in strokes, do not rub. Leave until sunken in, up to 20 minutes. Then apply a thin layer of the steroid. Do not scrimp on it. As a pp has said, a steroid is not great for skin, but eczema is fr far worse.

With creams in pots, use a spatula or spoon to get cream out, not your hands, as you do not want to contaminate the cream.
Apply the moisturiser every nappy change if the skin looks dry. Keeps using for a few days while there are no symptoms.

Hydromol ointment is good if it is very bad. For light moisturiser, we recommend Aveeno cream (oats are active ingredient), and Lush Dream Cream (essential oils).

Do not put anything in the bath water, though you can try a sock full of porridge oats (tied up) which you can squeeze.

If you are offered allergy testing, do have it. DS's skin is transformed now

Fwiw, we were prescribed HC 2.5 for face, and mometaaone furoate 0.1 for body. 0.5 HC did nothing

Yes to getting out the cream with a spoon and not your hand, totally forgot about that. Our dermatologist told us that. We went to a big London hospital too. Have you looked into the cause of eczema? For us it was because DS has a dairy allergy.

We haven't looked into the cause of the flare ups yet. And now on day 5 we have yet another flare up, on the neck area which had just calmed down a day ago!

gp appointment now booked for 8 jan. so far the gp has just been telling me to moisturise and prescribing different moisturisers. Going to see if can get an appointment earlier now....

Once we do get to the other side and the eczema is managed, what is the routine you follow each day on moisturising frequency?

Aged 5 and 3, we are on twice daily. I'd go with every nappy change.
We were probably 3 times a day from 1, when I went back to work, with cream at nursery for flare ups.
Did you stop the HC on his neck after it calmed down yesterday? I'd recommend carrying on with at least 2 days after it looks to have gone before stopping.

Are his knees and elbows OK? Just his neck and face? Does he sick or dribble milk? Could it be a reaction to anything like that?

Please don't let the gp tell you to moisturise more of just give you a different one! It drove me nuts. If your DS has had an intense (fairly long)course of a steroid and the eczema hasn't cleared up then they need to try something else, a stronger steroid, Protopic or a dermatology referral.

Now DS's eczema's managed we moisturise (Cetraben) once or twice a day and put E45 oil in his baths. If there's a little patch of red developing I apply the Protopic to the area. I use non-bio washing powder and sensitive conditioner. We haven't cut out any foods. This is from upwards of 15 times a day moisturising and 2x steroids to no avail about 6/8 weeks ago. It's definitely the Protopic that's working as we forgot it when we stayed with my sister for a couple of nights and it started to come back ()

Following on to what addictedtosugar said, DD had red patches on her chin/neck when she was younger and we discovered it was caused by this. The doctor had prescribed steroid cream without really knowing what it was, which I wasn't happy about. I did research on here and found lots of recommendations for Aveeno cream. We tried it and it cleared it up very quickly! We now use it on her face every night after her bath and it hasn't come back.

To add to the numerous and very good recommendations... Exomega cream by Aderma. I use it with DS since 5 months (now 11 months). has kept flare ups at bay after repeated flare ups which required steroid creams when younger. I order it online from Boots.

I had eczema all the time as a young child/baby. Most flare-ups were linked to an allergen (either on the skin or eaten), and it was persistent because not all of those allergens could be removed (cotton being one!). Now I'm an adult, and I wear synthetic fabrics as much as possible. Problem solved!

My bf baby gets terrible rashes if I eat pineapple, or haribos (the worst, was like burns on her skin!). I couldn't eat any citrus fruit while bf my son for the same reason. Get your child allergy tested, then you'll know if there is anything you can avoid.

Eczema also on knee pits and one elbow pit. Plus armpits, back and torso. And ankle crease, and some on legs too. But the face and neck are the worst affected.

Yes there is lots of dribble, and breast milk over his face which is also probably why the regular washing seems to help.

Exomega reviews does sound amazing,and specifically for babies too. Have ordered from Boots....

Thank you all again, and happy 2015! I'm much more hopeful now that at least we can get to a managed state in a couple of weeks. Will try stronger steroids then protopic as next steps if hc continues to fail.

I suspect I'm still in denial and am still trying to find a cream that will bring his skin back to "normal".

But funnily no eczema in his cheeks where there's most contact with milk.

@addicted I did put less hc on his neck when calmed though didn't stop

I will do allergy testing if the other steps fail. It is likely to be something w can't easily control, just have a feeling.

His skin will be better. DS had top to toe eczema as a 5 month old baby. With the right course of steroids and emollients from the dermatologist we got his skin looking beautiful again. The only problem was we had to pay for a private appointment as the GP told us to just moisturise . But it was worth every penny.

My ds is now 12 and has had eczema since 4 months. We tried all sorts of lotions and potions some of which helped a bit but nothing made it go away. He was allergy tested but came back negative.
We've noticed that the central heating and cut grass makes his skin worse.
Following 2 weeks of cetreban and hc 1% with his skin still flaring up I followed some advice on here and purchased some AVEENO cream and shower gel. He's just using cream morning and night on body and once or twice more on his hands. He's been using this cream since Sunday night and his skin is now clear of any red inflamed patches. Wish I'd got it years ago.

DD had horrible eczema all over her torso and legs until our GP decided it was food related and referred to a paediatrician.

He took one look, declared it non food related eczema and prescribed Elocon, Aveeno and 50/50 paraffin and water.

We applied the combination daily for five days - eczema now completely gone with just the odd patch behind her knees and on her chin, so we do the same again to clear the patches.

The paediatrician said the latest research tells us that high dose steroids applied for a few days are much better than low dose hydrocortisone over longer periods, but most GPs are not up to date on the research, unfortunately.

Yes to what funchum8am said-it's better to have stronger steroids for shorter periods than weaker ones for longer (especially if they don't totally get rid of it).
I was worried that it might be my bm at first too! His eczema was on his cheeks and around his ears at first so just where it spilled out when he was feeding but it soon spread to all over his torso

Thank you for the reassurances! Based on advice, have now spread much thicker hc on face and neck to try and contain the flare today - fingers crossed.

Btw, somewhat unrelated but could we have a poll on whether LOs with eczema had had exposure to antibiotics in early life or during pregnancy My DS had an intensive anti-b course at 1 week old.

Another question, do you continue to apply steroid cream to skin that is no longer red but is rough?

DS' legs have been in this stage for a while - 3-4 weeks without steroid application. Should we apply till it's smooth?