Any ideas what this rash might be???

[thebluefoxategreensocks]

Just wondering whether anyone has come across a rash like this before? My 2yo son has had it covering his back for over 2 weeks now. It started out fairly high on the back but soon spread to cover most of the back (areas he couldn't even reach to scratch). It's evidently quite itchy though! He has rather severe eczema (all over his body, nearly!), but this rash seems rather different. Mainly in that it won't respond at all to any emollients! The eczema varies in its intensity and when he gets covered in Epaderm at night, provided he doesn't scratch too much in the night, the eczema is fairly calm by morning. But nothing seems to have any impact on his back - and it looks different too! The closest I've come to dealing with it was using Calamine lotion - I nearly thought it was clearing up, but that didn't last and it's gotten worse the past few days.

Anyway, I know doctors have to diagnose things! But I'm getting various opinions without any firm ideas or solutions! One of my midwives (who's own son has eczema) was sure it was a form of eczema; I took him to a GP later that day (about 1.5 weeks ago) and she thought it looked viral rather than eczema (the rash did have occasional spots with heads mixed in around the neck area at that stage); and then I took him to a different GP on Monday and he said it wasn't viral, but perhaps something eczema like though maybe infected? So he prescribed Fucidic acid cream - and is going to write off to get us a referral to a dermatologist (for eczema in general really) but that could take ages! Soooo, just wondered if anyone has any ideas what it might be - it's not nice!

Here is what it looked like on Monday:

i278.photobucket.com/albums/kk108/rachins_photos/misc/rash.jpg

i278.photobucket.com/albums/kk108/rachins_photos/misc/rash2.jpg

and this is what it's like tonight, having gotten rather worse last night/today.

i278.photobucket.com/albums/kk108/rachins_photos/misc/updatedrash.jpg

I don't think the fucidic acid cream is working - but then again, I didn't really feel the rash was infected anyway! So don't really know where to go from here.

This is what the eczema on his feet looks like, which is quite different in many ways to the odd rash on his back:

i278.photobucket.com/albums/kk108/rachins_photos/misc/rash3.jpg

Any ideas?? It's quite stressful trying to deal with this at the moment, as I'm 40w 1d pregnant right now! And he's already waking in the nights with the eczema...so the rash on his back only adds to the problems! But so far visits to the GPs have proved fairly pointless, as they don't seem to really know what it is!

An oat bath is good, but something with an emollient will do wonders for his skin! If the Oilatum you used came in a blue bottle and was just called 'Oilatum' beware - it contains a fragrance, as does Aveeno (although I agree this one is better than Oilatum) so neither of these will be ideal. Make sure, if using Oilatum, it is the specific Junior one, which is fragrance free. However, I don't really credit Oilatum much. Epaderm is really one of the best emollients you can get your hands on and can be used in the bath water, to wash with and then as a moisturiser on the skin as and when needed throughout the day. Have you been prescribed any steroid creams/ointments?

I agree with regard to Epaderm - so far it's the best we've had! But if I apply it during the day, I think it's just too thick and makes him more itchy. But it works very well on him at night, and his skin looks quite soft when he wakes up in the morning.

Yes, we've been given steroids for him, but they've only made the eczema worse...so I'm keeping far away from them for now!

Tree - I understand your worries - as a Mummy I have the same response to things starting in 'para'! However, when viewed as medicine for the skin, I cannot sing the praises of prescribed emollients more highly. You may have to try several before finding the one most suited to your child's skin, but they are crucial to good management of eczema (as are topical steroids where needed but that's a-whole-nother thread...!!).

And while not necessarily natural in their make-up (as in organic, or essential oil based etc) you can get some that are pretty pure (i.e don't contain masses of scientific crap!!). 50/50 for example contains only 50% white soft paraffin and 50% liquid paraffin and works fabulously on very very dry skin and also on skin that may well react to those emollients with a very long list of ingredients. Use it all over the skin, but be warned it will get into their clothes and will likely erode the rubber bits of your washing machine over time - but if it works it's worth getting the seal replaced once or twice!!

Having said all this, my son has had excellent results from a product called Eucerin which has an ingredients list as long as your arm - paras all over the place, but clearly doing good work, so we are going with it!!

As for bath stuff, see my last post. Epaderm is fab, but the key with bathing is NO SOAP (i.e nothing that will cause bubbles)and NO SMELL. Some bath products that come from reputable brands (Aveeno, for example, do some excellent emollient creams and lotions, but whose bath stuff has a fragrance , Oilatum is the same - bit misguided on their part really and such a shame as them people think it's not v good and write the whole lot off!). Equally sometimes people put lots of good emollient stuff in the bath and then compromise it all by washing their children's hair with soapy shampoo at the end of the bath!

Our dermatology doctors recommend regualr, even daily bathing, but using the bath as part of the therapy (i.e to compliment the whole skin care regime) is key.

Rach - Epaderm have just brought out a lotion which is much lighter than the ointment and may work better during the day. Some people do find it's really a bit too thick and greasy - I guess it depends how dry his skin is. Putting something over it like a close fitting vest or tights (even for boys!!) or tubifast garments may help as it absorbs some of the greasiness and also holds it next to the skin. The lotion is a really nice consistency so you could always ask to try some for day times. A lot of people choose only to use epaderm ointment at night, because of its greasiness, so if it works, keep it up!

In what way did the steroids make the skin worse...?!

Interesting - if thats your experience it is very powerful, although not avtuall what I want to hear iyswim. DD goes no where near any soap of any description, and is free of sls and sle etc. Maybe I should make friends with the prescribed stuff again ..

Anyway will stop interupting and let Rachel have her thread back

But misspollysdolly I have your name, I will be caaaalliiiinng for you nou doubt in the future

As for steroids, prior to using them, we'd always been able to control his eczema - never really got out of hand totally and had never seen a GP about it either. He'd had the eczema since at least May last year. It was around the end of January this year that we tried the steroids...because the eczema appeared on his face and we couldn't cover it up to keep his hands from scratching!

Well, the eczema that returned after a 10 day course of steroids was far worse than we'd ever seen before! I then found out you're meant to go off them more gradually (which the silly GP never told us - he just gave us a prescription as fast as he could and bid us goodbye!). Anyway, so about a week later we did another course of the steroids - this time for about 7 days, and came off them gradually. The steriods both times cleared up the eczema quite well - but even after coming off them gradually, the 2nd time was even worse than before! And it's been bad ever since - with his feet looking quite damaged too. So, I'm scared of steriods now! And the GP we saw on Monday seemed to agree that steroids were making him worse and we should avoid them!

tree: Don't run away!! You're always welcome on my threads!

Which steroids did you get given? Was it 1% hydrocortisone for his face? This is very safe, very mild and could be used - according to our dermatologist - 'every day til your 90' and would never be a cause for concern! Therefore there is no need to be rushing to finish using them. If this is all that has been prescribed it is worth considering that it is also THE mildest, so on some stibbonr areas, may actually not be strong enough to do anything lasting for long. The next stage up is eumovate, would is still in the mild-moderate potency bracket and can be used safely for shortish bursts (but as you say, not being stopped too abruptly). Concern about potency and skin thinning come into play when you get to cream like betnovate. (Our chappie explained to us in term of hydrocortisone being 1 in terms of potency, eumovate is 2.5 (times stronger) and then suddenly you get this huge jump to betnovate being 25 and dermavate being 50 - that put it inot perspective a bit really - he generally prescribes hydrocort for faces and eumovate ofor everywhere else and advocates regular - twice daily - use until the eczema is very well under control)

In the clinic we always have a step up, step down approach and aim for families to be using as little steroid as is necessary while promoting the reality that sometimes for periods of time it is necessary to keep using the steroid creams. Unless he is sensitive to something in the creams (in which case he would react to them topically at the time I should think) they are unlikely to cause his eczema to worsen. However, underuse of steroids is as much of a concern as overuse.

The advice is split about whther to apply the steroid first or after an emollient. Hoever either way is fine as long as their is a gap between the two differnt preparations. Therefore, either the emollient should be applied, then you should wait 20-30 minutes for this to be absorbed before applying the steroid cream/ointment to any areas that are itchy, red or inflamed.
The other way of doing it is to apply the steroid first, THEN to wait 20-30 minutes before apply a good layer of emollient. Either way is fine, it's the gap for the first thing to be absorbed that is key. Otherwise you just dilute and/or move the steroid around and it doesn't do a good job, oor it just sits on a big thick layer of emollient before being wiped onto something else!! Our dermatologist favours the steroid first approach, but I know a lot of others would give the opposite advice! So much advice is given and it can be SOOOOO confusing for everyone, can't it?!

Generally it sound like you have been trying all the right things - it gets me so frustrated though when people don't get enough of their GP's time or attention or get masses of conflicted/confusing advice. I hope it gets sorted soon as it can be so miserable for all of you. Hope this has helped and happy to chat anytime. Away now for a few days though, so won't be around! Try and get a referral to the nearest children skin clinic. Hope his funny rash clears up soon too!

Haven't read the whole thread as just about to go to bed but looking at your pics its exactly the same as the rash my dd had a little while ago.

GP said it was viral and gave her steroid cream and moisturiser but tbh they didnt' really help and it eventually disappeared on its own - took a while though.

DD ended up at Great Ormond Street with her eczema, as it was so bad. Dr Atherton prescribed a special mix for her that needed making up by the pharmacist. It's basically 1% steroid (if I remember correctly), mixed into sterile vaseline, and then applied quite thickly, with a hot wet tubigrip bandage on top to encourage it to soak in better, and then a dry tubigrip on top of that. Piriton for any associated itching because of the bandages. If she wanted to go swimming we had to wrap her limbs in cling film to stop the chlorine aggravating the eczema.

She was really very bad but this sorted it out like some sort of miracle cure, and there were children worse than her at the clinic who had benefited from this as well, according to Dr Atherton.

Might be worth some investigation.

I haven't read the entire thread (who has the time with an ill child). My son has the same looking rash. He's had it for 2 weeks. Did you ever figure out what it is?

It's DEFINITELY eczema. You will find over time that they will get the eczema in every different form possible unfortunately, it will not alway's show itself tin the same way all over the body. IMO I would not bother with the Fucidin cream and go for oral anti-bs-Co-amoxiclav if possible.
If you find piriton does nothing then you could possible try 'cetirizine', I find these things are best given first thing in the morning.BIGGEST thing is to keep them cool, ask for some wet-wrapping stuff to put on just to cool the skin down which will stop the itching so much.
We have seen many specialists over the past 4yrs and now seeing a 'specific peadiatric eczema specialist at the John Radcliffe in Oxford, any advie then give me a shout x