let down by GP over baby's eczema

[soontobeamum1982]

Argh i'm so fed up and upset. We have a family history of asthma/eczema/allergies on both sides so have been looking for it. Until now DD (6 months) has had eczema very mildly, and controlled by moisturising etc. Now we've started weaning it's kicked off badly - all over her face, swollen eyes, worst under the chin where skin in now peeling. And this has come from nowhere in under 2 weeks. Been to the GP twice and they just say keep going with Cetraben. Meanwhile it's getting worse, she's not sleeping or feeding properly as so irritated, she's refusing all solids (not that she was that interested from the off).
Took her to out of hours last night as her face was terrible and she also had a rash spread all over her. They gave some piriton but otherwise unfussed and said no point in allergy referral. Why not?
I'm going back to my GP tomorrow ready for another fight, but at this point I'm thinking of paying for a private allergy consultation as I really want to get to the bottom of it before it becomes so widespread it takes years to get rid of.
I'm not over reacting - DH has lived with terrible eczema all his life, has been hospitalised with it in the past, has to take the same immune suppressants that organ transplant patients take daily in order to keep it under control (and has to have his blood tests every month to check they're not wrecking his kidneys). Meanwhile I have food allergies and am terrified about weaning - daren't introduce egg or anything.
Why the hell won't they help? I've paid tax all my life (and lots of it) and now we need support I'm looked at like a panickly first time mum.
Gah.
Does anyone who has had a similar experience have advice? Any miracle cures? I'm 99 per cent sure it's CMPA at this point!

www.ncbi.nlm.nih.gov/pmc/articles/PMC2553152/

7 day wash out recommended here. Practically I tell mothers it can take 2-4 weeks. 6 weeks is ridiculous. If it's not improving after 6 weeks, it's not because of the CMP.

Just to reinforce the good advice you’ve been given OP, as a parent of 4 children all with eczema two of which have allergies which require them to carry epipens, please if prescribed steroid ointment down the line do not be afraid of using it as per your clinicians advice. So many people think they know better and use less over a longer period of time then wonder why it doesn’t work. My youngest has been under the care of Gt Ormond St dermatology and St Thomas’s Allergy dept for the past 8 years and while at 12 now he is not completely clear of eczema it is definitely manageable now. After in patients stays immunosuppressants bleach baths prophylactic antibiotics and oral steroids we are now able to manage his flares with different strengths of steroid ointments and emollients. I now believe had the gp not kept giving us the standard moisturisers and 0.5% hydrocortisone for 3 years saying use sparingly instead of referring to a dermatologist sooner my son would not have got so bad . I also realise that GP’s are limited to what they can prescribe, but feel that some do not take eczema and the effects on the sufferer and family seriously enough. He also has food and environment allergies which irritate his eczema but they’re not the cause he is extremely atopic and has asthma too. His eczema flares are always brought under control now with the steroid ointments but only as prescribed and this use is getting less and less . Good luck OP hopefully your little one will be clear soon

My DS went through the same problems you are describing. The cream the GP recommended, aqueous cream, made it much worse. The HV was shocked as it is well known to exacerbate eczema. Eventually we went to a skin specialist. He prescribed stronger steroidal cream which he said was necessary to bring it back to normal levels. It worked. He has occasional patches of eczema now which cetreben is excellent at treating.

Good luck

Even though it is because if a food is removed there is no way it can still be causing problems and triggering the immune system 6 weeks later.

In breastfed babies yes it can.

You really have no idea. Piriton is an anti-histamine. Histamine plays a negligible role in the itch with eczema. You really are confused by the types of immune reactions. Steroids dampen down an intrinsic T cell driven reaction that is the biggest driver in most eczema, and won't have any bearing on how foods are introduced, or the determination of triggers. For the vast majority of children (not your DD) steroids are treating the intrinsic problem with the sufferer's immune system.

Again, you've implied steroids aren't the answer. Do you think they should play a role in the first line treatment of eczema?

In breastfed babies yes it can.

No. It really can't. Show me any scientific evidence of CMP being detectable in BM at 6 weeks.

Hi. My Ds also has eczema and food allergies, asthma as well, so classic atopic child. Our first clue about his food allergies was severe red rash reactions to any contact with milk products on his skin. So it worked rather like an accidental patch test. In fact the worst incident was contact with a supermarket child restraint strap (probably soaked with milk) on his neck producing a red lumpy violent rapid reaction.

His eczema improved with the removal of dairy eggs chocolate from my diet while still breast feeding, when his red raw weeping cheeks healed. Best combination for us (some years ago) was Balneum bath, aqueous cream, Diprobase, hydrocortisone. He still uses Diprobase and very occasionally hydrocortisone on his hands.

In addition we used dust mite covers for mattresses, pillows, Filetti washing powder, cotton duvets and blankets all washed at 60 degrees and wooden flooring in bedrooms.

We saw a private dermatologist and had allergy testing with Dr Lack.
He still has food allergies though the number and severity of reactions is greatly reduced.

Good luck to you and your Ds. It's a long struggle.

And your rationale makes no sense: if you're saying the CMP is causing the problem and detectable by skin prick testing that suggests you think the eczema is a CMP-driven type I hypersensitivity reaction. If you're saying it can takes weeks to resolve your saying the eczema is a CMP-driven type IV hypersensitivity reaction. Which is it? Or are you saying it's both?

NotBadConsidering
Why was my hospitalised baby given piriton to relieve her itching if it does not relieve itching? My daughter's severe eczema was an allergic response to dairy. Piriton helped relieve the severe itch. I use piriton for allergic reactions that are severely itchy and burn. You are the one saying eczema is not an allergic response to food. I disagree, from personal experience! I'm not giving advice here. Just stating my own experience.

Piriton will relieve itch when there is histamine involved. There will be histamine involved in type I hypersensitivity reactions. So it will work for a lot of itchy problems. Most eczema has no histamine involvement. It is prescribed in hospitals for two general reasons: nurses ask for it when they see a patient itching and because it's sedating children can itch and scratch less in their sleep.

I'm saying eczema is not an allergic reaction to food based on clinical evidence. As I've said before, your experience with your DD is not typical. You can't disagree with the consensus of paediatrics around the world; your single case of your DD doesn't make everyone else wrong.

OP push for a dermatology referral (although that could be a long wait).

When my DS10 was diagnosed with excema as a small baby I was lucky, my local GP has a special interest in both Paeds and Dermatology and was up on all the latest research on treatment protocols.

He explained that it's best to treat a flare up with a short sharp dose of a potent steroid (we had Elocon) and then once the area is healing and the itch scratch cycle is broken, follow up with a well thought out routine of emollients to keep it at bay. The real issue with steroid use is that most GPS prescribe a low dose cream that doesn't solve the problem and then is used for far too long.

This really worked and has continued to work for us. DS is and will always be atopic (as am I) but he is rarely bothered by his eczema at all. I really wish I'd had better treatment when I was a child. Being a child with eczema in the 1970s was really no fun at all.

To be honest though eczema can be a very complicated skin condition. It is not necessarily caused by one thing alone. It could be a mix of things. Allergies and genetics. Just allergies or just genetics. Some things work for some people and not for others

notbad thanks for the tip off although she was given that years ago and i have since read some things that weren't great about it although i can't quote as i can't remember.....i have ordered in from good old amazon a few different things to try namely....Aveeno cream & Dr Organic Bioactive Manuka Honey......... having said that, i may give the elidel a try again, thanks

I'm in the camp that says try dietary changes. I have sorted a chronic skin condition in myself with dietary change when all GPs could offer me was long term antibiotics. I've solved the skin problem of one of my children with dietary change too. But it has to be carefully done and mindful of continuing to get all the necessary nutrition. I've nothing against medication btw, only that it doesn't solve the underlying problem, just damps down the immune reaction and in my case gave me dodgy liver test results.

I've also been reading quite a bit about the the body's microbiome, especially our gut flora and the link to autoimmune diseases. 'I Contain Multitudes' by Ed Yong is absolutely fascinating.

Depending on our life experiences, from the mode of our birth, what we eat, what we touch, who we live with, where we live and what medication we take, we can end up with very different populations of microbes in our bodies and this can affect the immune system and our inflammatory response.

They're not some miracle cure but can babies be given pre or probiotics?