Use of hydrocortisone on face .... any advice please

[Portree]

DS, nearly 7, months has eczema. I am slowly working my way through the myriad of treatment solutions (I have a list! and I'll dangle him by the ankles if I thought that would help). Today his face has flared up like never before - in front of ears, lower cheeks and under chin. Dr gave me HC 0.5%.

Q I know to only apply twice a day, but do I continue applying it every day just until the redness has calmed down or until it has disappeared completely?

Q Am I right in thinking that this mild cream will not cause skin thinning ..... if it's dependent on frequency and duration of use then how frequently and for how long would I have to use it for his skin to thin?

Many thanks, Portree

Sorry to hear about your poor DS, it must be driving him nuts in this weather (I'm assuming the sun is shining where you are!) 0.5% HC is really mild and can be used on the face. Skin thining doesn't happen until you start using really strong creams which would be prescribed by a dermatologist and not your GP. I personally would keep using the cream until the patch disappears completly. HTH, it's just my own experience and opinion at the end of the day. Good luck

Agree with Kim use it thinly until the flare disapears but if it becomes "weepy" or bleeds take DS to the doctor as the HC by itself won't cure an infection. Don't be tempted to use it all around the body if your Ds is covered in flares. he would need a different treatment in such case.

Use the hidorcortisone but keep applying emmolients as often as it is needed, I found Eucerin lotion very useful (though it sting if the skin is cracked). Forget about aqueous cream and get at least Hidrous cream or Diprobase.

Regarding question 2... 0.5 if correctly used won't make any damage, is incredibly mild.

Our dermatologist told me something that really put my mind at rest about using HC,he said that the damage caused by non treated eczema was far worse than the damage caused by the hidrocortisone, the important thing is to use it as a part of a program so you can keep its use to the minimum: oilatum baths, lots of emollients, antibiotics when infected and yes...anthistamines if the itching is truly out of control.

Good luck, if you need any help more info, please let me know DS went through that last year and I understand how difficult it can be.

DD (8 months) has eczema too and her face is always the worst affected. I use a 0.5% hydrocortisone on it, as prescribed by our GP. He said we can be quite relaxed about the judicious use of that strenth of hydrocortisone on her face - thinning wasn't a problem if you are looking at light applications of a fairly mild cream.

If it helps, the major thing that I have found has helped is me relaxing and accepting that she has eczema it (and unfortunately she has been a poor scabby little thing at times!). I started off thinking maybe there was some magic bullet that would make this go away and that if only I could find out what it was the excema would disappear. Now I don't think that is the case. On the drs recommendation she is off dairy formula and on soya (lots of views on these boards on this, and I have read them and do appreciate every one's point of view but at the end of the day I've decided to follow GPs advice). She has goats milk yoghurt and goats cheese. Double base (emollient gel) at least 3 times a day. Bath every day. Cotton clothes and these washed in non bio detergent (occasionally I give them all a wash in bio and an extra rinse as they look so grimy). Socks over her hands at bedtime because she loves a good scratch. And to be honest I've found that the only thing that shifts the eczema when it is bad is hydrocortisone cream - I'd love to say that any of the organic miracle creams you read about work but for us they don't seem to . DD is a lot better under this regime and more importantly a lot happier. It seems to flare up when she is teething - no idea why but it certainly seems to be more than coincidence. The doctor said we should think about management not cure, which I have come to relise is about right!

HTH. BTW I breastfed her for 6 months, and only breast fed DS1 for 3 months. He doesn't have any eczema at all!

Chandra - your stuff is good. Forgot about oilatum in bath: very important. Also agree re leaving it untreated is worse: I was applying too conservatively and the dr said that the skin really needed to be cleared up to "realise" what normal skin was like and replicate it (I think he said it in a much more eloquent and medical way than that though!)

Anchovy, we had a bullet remedy which was the combination of Emolytar (tar based bath oil not available in UK), Eucerin, antiobiotics and anthistamines, and mometasoane(another corticoid that we hardly used as the threatment made such a difference). It only took 4 days for the skin to look baby-like which was unbelievable considering that few days before he was covered head to toe and bleeding from every skin fold.

Eczema has returned this year but only in the face, sadly he is not responding to the treatment any more but I expect that he will grow out of it for next year.

I'm new to mumsnet .. is it always this quick? Much quicker than trying to speak to a GP or HV. Wow. Thanks for the sound advice and reassurances.

Luckily DS doesn't scratch at his face, only his tummy and ankles when he has access. And I think he's at the mild end of the spectrum. I've tried all sorts of ungents, lotions and potions from the doctor and the only one that DS seems to tolerate is the diprobase but only for a few days at a time. Aquaeous cream, Edpaderm and oilatum make him scratch. Eucerin is on my list of alternative creams to try, so I'll give it a go.

DS eczema only started after weaning and specifically after he started on nutramigen to mix his rice and breakfast ..he's sensitive to cow's milk formula and I couldn't express enough. Before that he had a little dry skin on the sides of his face and before that craddle cap. I'm not convinced that the nutramigen hasn't got a role to play but he's sensitive to Nanny too and the soy formula caused a runny and exploding bottom! Dietician said it was unlikely to be nutramigen causing his eczema as the protien has been broken down but she did say that in the past she has had a few cases of nutramigen causing a skin reaction. I'm still bf but would love to stop and get my body back. I'm so anxious to make sure that he gets enough nutrients that I'm loathe to cut out the nutramigen (about 8fl oz a day) but maybe I should stop it for a few days and see what happens.

just to add sometimes the creams themselves can cause problems dd is allergic to oilatum in someway and it made her worse - we now use johnsons baby moisturing cream and it is all indercontroll I can not believ it esp when she 7mths she was an abs and ah medicine

ezcema rules our house. dd1+2 have it as does dh. only i am free of it.

i dont belive that ezcema can be 'cured' and belive that better management can make life easier for everyone with ezcema. which is why it can take up 2hrs to get the girls ready for bed each night. even with correct treatment and a good routine they still flare up. dd1 skin is under control, dd2 skin is almost there, no ifections but a bit red in creases. dh is ok cept his back is a bit messy atm.
I have used hydrocortise on each of dd's faces. the highest we went with dd1 was 1% and we used it for a maximum of a week but her face was really really bad. dd2 has a small patch on her cheek atm so has 0.5% applied sparingly twice a day atm. we have 1% for the other patches. all day we are reapplying dermol500 lotion to both of them, then the evening baths with oilatum plus.
The use of steroids, when used correctly and under docs supervision are ok. i do worry about skin thinning, and one of the side effect dd1 suffered with hydrocortisone treatments was think black hairs growing. as she rarely has the hydrocortisone creams anymore the hairs have almost gone. but when dd1 was younger nothing would get her ezcema under control, she was on conttant anti biotics as she was getting infections week after week. she actually had several short courses of oral steroids coupled with stronger creams and antibiotics all at once. if we have to now dab a bit of hydrocortisone on every now and then to keep it under control and in a managable state then so be it.

hope your sons skin clears up soon and becomes managable.

Portree, welcome to Musmnet

I found regular oilatum a bit useless, specially comparing it with Emolytar, but I have heard great comments from other people. DS is now using Oilatum PLus (with antiseptic) once a week, and Emolytar the rest of the days.

I have not tried the following but many are swearing by it, oats in a piece of fabric or sock, etc and run the bath water through it.

Eucering was great for us, we used to cover DS body in diprobase hourly, with Eucerin we only needed to do it three times a day. Which made a huge difference. Your GP can prescribe it (it is not listed as Eucerin but they can prescribe if you mention that the active ingredient is Urea) 10%. We use Diprobase only when the skin is cracked as it doesn't sting.

I do also agree with Gothicmama, sometimes they developed allergies to creams that were very useful we used Lipikar Baume for some weeks and now he is allergic to it. Same goes for acueous cream, if he gets allergic to Eucerin we would be in serious problems

Before I go, something very important is to apply the emollient in the four minutes after the bath to lock in the moisture. And to leave a space of half an hour between the emollient and the corticoids other wise they diminish the effect of each other.

Misdee, have you hear of Tacrolimus? It's a new medicine that controls the exagerate immunologic reaction of the skin. It has not been tested in under 2s but seem to have wonderful results in older children and adults. It cleared DSs flares faster than HC (well, tbh he doesn't respond well to HC, he had been in HC 2.5 for weeks when we got Tacrolimus prescribed). It seems like a good solution for chronic eczema, needs to be handled with care though...

Poor you Misdee, that sounds bad .

Portree, I think one thing you have to remember is that no one solution works for every baby so you have to just work out what's best in your case. My dd is fine with Oilatum for example, but anything by Johnson&Johnson really sets her off. She also reacts badly to Surcare washing liquid (FFS its recommended by the Eczema Society as well, the little monkey) And, as you probably have worked out it all becomes very expensive. DD gets through a large £12 tub of Doublebase once a fortnight and about the same with Oilatum Plus - ds at the same age used to get a plain bath and a quick wipe with a flannel!

Anchovy, I get Oilatum Plus on prescription, maybe if you ask your GP you can get it as well?
Agree with you on how expensive it could get, at the height of the crisis we were spending nearly £80 per month, until somebody relised of that and started prescribing them for us. Still need to get the Emolytar from Spain, and at £15 per bottle it doesn't come cheap...

chandra. Tacrolimus (protopic??) is a relatively new cream and is very very expensive. most gp wont perscribe it. i belive it came available here about 2yrs ago, around the time dd1 ezcema bcame more managable, and the only people who could perscribe it where specialists. the nhs i belive were very reluctant to perscribe it. it does make people more sensitive to sunlight, and altho loads of people rave about it, some people find it doesnt work for them. as with everything ezcema related, what works brilliantly for one may make another person react badly. eg some people recommend e45 products, put it anywhere on dd1 and she will scream as she says it feels like its burning.

we have found it easier to cope as time goes on with good skincare treatments. but even then one of the girls will wake up with a case of the itches.

seriously, get as much as you can on perscription. if i had to pay for the treatments i'd be paying around £100 a month too.

yes Protopic, we used to pay 60 euros for a tube! we have it prescribed by a dermatologist, when we finally got a dermatologist at the NHS she insisted to carry on with it, the sensitivity to light is common with many skin products but if you use the medicine sensibly there are little chances for it to develop. Reading the info file that comes with medicine I got very worried but it has keep him clear since December and we don't need to use it very often. We had to stop it because he is going to getthe MMR so we are back with HC, and again, is not responding to it.

message withdrawn

i'm glad you mamanged to get it perscribed for you. i tried endlessly when it first became available, as did a lot of parents of the ezcema group i belong to, but i thinkl only one was successful and i think she went private. i have found it hard getting the treatments needed at times. one gp told me i was going thro too much dermol and did i know how much it cost. i wanted to throttle him.

Robin,I'm interested in your view of probiotics, have you used them? I was surprised to come across a reference to them in the BMA guide to eczema, a study done in Finland. Do you know of a source of further information? Just wondering if it's any old probiotic or a specific bacteria. Haven't managed to google any concrete info. It's something that's on my list for both me and DS. I think that powdered form is available for babies.

Portree - Have not read all the replies, so sorry if I double up on anything. We use 0.5% ointment on ds's face as and when needed. It is used twice a day until the eczema dies down, at which point we go back to Unguentum Merck emollient, or vaseline. My GP advised me that the eczema will cause more damage to the skin than the ointment, although there is some skin thinning with its use.

We use 1% hydrocortisone on ds's face, twice a day when the eczema is red. When it starts calming down, we use it once a day and when his eczema has gone, we don't use it at all. It's important to gradually reduce it's use, complete withdrawal causes a flare up again.

We apply it, then leave 30 minutes before applying his usual moisturiser, Cetraben. This allows the steroid to soak in and not be diluted by the moisturiser.

The dermatologist says that it's cruel to NOT apply steroids when required, it causes more damage if NOT applied and it's bad press regarding skin thinning is from the 1950s. She says it will thin the skin but only if it's applied extremely regularly and if the doctor's instructions aren't followed and a strong steroid is used so 0.5% is the weakest of the lot.

We've been using it since ds was 3 months old, he's now 16 months and he doesn't have any skin thinning.

Good luck. We're currently going through hell with his eczema and I really wouldn't want to wish it on any family.

G

My dd had elidel (protopic) prescribed to her when she was in usa with really bad eczema (flares up every time she gets on a plane). She was only 5 months old at the time. Our paediatrician said to use it on any bits where it was so bad that it was cracking and bleeding and to use eucerin and hydrocortisone otherwise.
A few months ago I went to gp's to get it prescribed here in uk in anticipation of getting on a plane to the usa as we weren't going to see paed there for several weeks after arriving. My regular (super lovely) gp was on holiday and we saw some young whipper snapper who looked like he was barely old enough to shave. He said he'd never heard of it, and when I insisted that it did in fact exist he looked it up in his book, gave me a shocked look like I had just asked for heroin for my child and said very severely that it was NOT to be prescribed for children under 2 (dd was 18 mo. at that point) and he didn't believe that I had had it prescribed in the usa. He insisted that hydrocortisone was perfectly adequate. I have since looked it up on the internet and although it hasn't been fully tested on under 2's, it is prescribed and seems to be very effective. Luckily I found the remains of a tube in my medicine cabinet before leaving.

Our GPs insisted that they could not refer DS to a dermatologist until they were sure it was not infantile eczema. Even when DS skin had been bleeding for months they insisted on that.

In the worst episode ever we decided that we couldn't let DS go through three years of misery just to discard the possibily of infantile eczema and went private. Dermatologist was horrified that he had not been treated by a proper dermatologist before.

Sofia, we have had the same reaction that you had from your GP but the next time they start with a stupid line like "in THIS country we don't..." tell them that in THIS country they do provided they have some medical speciality. Protopic it's not licensed for children under 2 yrs which means that a GP can not prescribe it but a dermatologist can and do if he considers it's needed.

Misdee, considering how bad is your family's eczema wouldn't be worth it to go private at least for a single appointment? I know it's expensive but you will get that money spent in remedies anyway. Protopic costs about £40 per a tube but we have had the same tube for almost six months and it's still 3/4 full.

Hi Portree
Please see routine given to me by a Professor of Peadiatric Dermatology as I set out on thread called: Severe scratching to the head by my 4mth old in Topic:Allergies. There are two threads and my post is in the thread with 18 messages.
The important thing is to bath the child twice per day and do not use detergents, only acqueous cream to wash child/remove skin skuff/bacteria. I used steroid cream everyday for 1 week, then twice in one week now we are down to very occasionally. He hasn't had an application in three weeks! It's such a relief.

message withdrawn