To ask for referral? Any dermatologists about??

[sjtalk]

Help!

I have two DS with eczema. They have the usual bad patches in knees and elbows, but they are also covered in rash and dry skin. Our routine is piriton twice a day, diprobase moisturiser twice a day (we've also tried hydroderm, epiderm and childs farm - all made it worse). Neither of them get on with bath oils. We also use steroid cream one week in four. I also use surcare laundry powder which has no irritants at all. They wash with a tiny bit of simple soap.

Trouble is nothing is working. The oldest was sobbing in frustration with itchy, sore skin last night. The youngest was awake until 10pm, itching. They both wake every night with it. I am at my wits end.

I keep asking GP for referral but I am getting a no.

Could it be food related? Or an allergy to petroleum or anything else I havent thought of?

Anyone else have any experience of this?

TheScandanavianWoman. I hear you with blood on the sheets. Least of our worries but making a mental note to buy new ones when we have this under control!

Aveeno oil is perfumed and really irritates them :(

Shame about the bath products as my dd loved a bubble bath and we used oilatum junior bath, which did create a few bubbles.
I give this and oilatum shower gel to my patients with eczema, it helps to have a product that is 'normal' especially for older kids who get fed up being different.
Good luck with your GP.

One other tip for itchy skin.. Oats in Bath. Put oats in teatowel or hanky and tie around tap so water runs through into bath. Supposed to be really helpful for irritation

Have you considered Salicylates? I'm allergic but only through touch luckily as food is a nightmare as it's in everything.

I find it's in lots of products that say they're "sensitive" like shampoo, soap and sun cream, washing up liquid, washing machine liquids (I can only use persil).

You can see a dermatologist but honestly they'll say it's trial and error. Good luck.

Hi, my daughter has eczema and had a recent flare up - I was recommended Hibiscrub for showering and it really helped her with the itching.

I feel for you OP. I’ve had eczema my whole life (although currently have it very well controlled except on my hands). I’ve seen dermatologists in the four different countries we’ve lived in. Here are some thoughts, I hope some of them may be useful:

There aren’t enough dermatology appointments available so it tends to be rationed to only the most serious cases. You might be able to see a specialist nurse who might have much more experience in ongoing care for eczema. Ask if there is an eczema clinic you could attend instead of a consultants referral.
Realistically you might have to go privately to see a consultant.

I have been subscribed “bleach baths” as recommended by cloud pocket in two of the countries I’ve lived in. The theory is that continued infection of the skin caused by scratching makes the eczema flare up. If the eczema is spotty it might be worth asking the gp about them. The bleach is very dilute and I didn’t find it triggered my very sensitive skin.

There’s a book called “the eczema solution” written by a nurse at one of the London eczema clinics (can’t remember which hospital) which has a lot of detail about how to apply the various creams etc for maximum efficiency. I found it quite cheaply on amazon. Despite the name its not about a cure or solution, just the best practice way to treat eczema.

Finally, I’ve had patch testing (through a consultant dermatologist) and whilst it was quite interesting, it’s not conclusive. I had a reaction to 4 of the 20 substances applied, but even after cutting them out my eczema has improved but only marginally. Firstly, they can only test a limited number of the most common irritants, and secondly it seems like my skin is continually becoming sensitised to things that were previously ok.

Sorry for the long post, hope some of it is helpful!

Theredjellybean has good advice. It's a huge journey of trial and error to find the right combination. Most GPs are fairly useless, I'm afraid. And a lot of dermatologists unfortunately.
I'm a strong believer in using steroids when necessary to get a severe flare up under control. Leaving a poor child to scratch their skin off is not a treatment plan and the GP has to come up with better suggestions. Their eczema will only get worse and also open to far more serious infection.

You could try Moogoo Milk Wash and Udder cream. I haven't used them but I've seen quite a lot of good feedback. Another thing is Pure Potions Skin Salvation ointment. It wasn't the magic bullet for me but it is soothing and, again, some ppl love it. Aveeno with colloidal oats is another brand to try.

Look up Dr Aron or the Aron Regime. There are FB pages too.
He is a dermatologist treating people around the world with outstanding results.
I followed him for over a year trying different creams on my son to no avail. He is now practically clear with the odd periodic patch

My youngest was allergic to the preservatives in the emollients, so we found using greasier ointments, that don’t have preservatives in helps. So hydrocortisone ointment instead of cream, you can buy otc if you lie and say it’s for an adult and not their face. My GP told me to do this!
We also use hydromol I think which is a bit tub of grease.

Might be worth cutting out gluten for a while to see if it improves their eczema OP. My DH has had it all his life and saw a dramatic improvement when he cut gluten out. He's not got celiac disease but for some reason he must react to gluten.

Thank you everyone for all your advice and stories.

I think I am going to need to spend a while convincing the GP for stronger steroid cream because the youngest had an infection behind his knee so badly he couldn't put his weight on it. They still only prescribed 1% hydrocortisone and antibiotics. Before that one dr in the practice would only give him 0.1% cream. Honestly!?

I've just done an extra round of diprobase on them both. Will go to GP for stronger steroid cream and if that doesn't work I will go private for tests.

I will also see if I can find a more effective antihistimine or longer lasting antihistimine so we can all get some much needed zzzzzzzz

Mumsnetters - thank you for being stars

DragonAndCakes how did you find out allergic reaction to preservatives?

GreatDuckCookery - I suspect food too. I have food allergies and my youngest has food allergies too, but wouldn't cut out a major food group without tests. Glad to hear it helped your husband though!

If your GP isn't keen on prescribing steroids ask for the next strength up which would be eumovate or trimovate (has antibiotic and antifungal in). These are still a fair bit stronger than hydrocortisone. Apply them twice daily still settled.

Hi OP,
I'm probably going to reiterate what PPs have said but here goes:
Use the steroid cream to calm the inflammation when needed, not based on a totally arbitrary schedule! The one week in four schedule sounds nuts and certainly not what our derm recommended. If the kids are red itchy & sore, use the steroid. Moisturise first (we use Diprobase as well), then apply steroid.
Luke warm shower or bath using emollient instead of soap. This really helps. Don't use the Simple or whatever, soap will dry the skin.
Definitely push for allergy testing. One of my kids was dairy intolerant which is often linked with eczema. He also suffers from hayfever and his eczema seems to flare up when the pollen count is high. This could be a total coincidence mind you.
One brand which really helps when he's having a flare up is Salcura, we got it from a pharmacy but it may be on Amazon.
Keep up with gone moisturiser and the antihistamine as much as you can.
Hope you get to see a specialist soon, it's a horrible bloody thing

I would push for patch testing when my eczema reflared as an adult it was down to me touching nuts to make flapjack for my partner. I knew I was somewhat allergic to some nuts, but didn't realise it could cause a solely topical reaction. Before I got the patch test, which clarified what and how severely I was allergic, no treatments worked and I was awake for hours each night with the itching.

Stop all citrus fruits.
Try and get a prescription for synalar c steroid cream.
NO soaps, ever.
Persil non bio. Never, ever Fairy.
These things stopped by little boy looking like he was covered in burns

As a GP there's a lot more they can give before dermatologist referral. What's the point in waiting weeks to be given a moderately potent steroid that your GP could prescribe in 10mins?!

Might help to explain to receptionists that it's an eczema issue as some drs might have special interest in skin. Patients seem oddly coy about sharing stuff with receptionists when in reality it is massively helpful in getting better care!

I think it would be a pin prick/scratch test for food related allergies. Patch testing is to test for contact allergies as the allergens are just placed on the skin of the back for a few days (under a big plaster) to see if the skin reacts.

I think just seeing another gp might help in the short term.

I literally just signed up to reply to this.

Our LO is quite a lot younger (7 months) and developed eczema head to toe about 2 months ago. After 1 month of seeing a GP (having given them a second chance when they booked us in to see the 'skin specialist') we went private (thank goodness for insurance). We saw a leading dermatologist who only treats children and I can't recommend seeing a proper specialist enough if its an option.

To give a different view to many others, they prescribed an incredibly mild steroid cream that could be applied twice a day forever and we were told not to slather on cream as that can be distressing for the baby and skin itself. Instead we apply an incredibly thin layer of diprobase every nappy change.

The eczema still flares up (and always will - heres hoping we are in the 50% who clear up by 5 years old) but it doesn't dominate our lives anymore.

Of course every instance of eczema is different and they might recommend something else for your boys but I found our GP (even the skin specialist) to not be very effective.

I have been thinking about you all all evening.
If you can't afford a private dermatologist, would it be possible for you to find a copy of the NICE guidelines online and take them in to see your GP? Last time I saw my GP, at my wit's end because I was suffering so much, he said let's look at the guidelines and see what we are doing right and what we are doing wrong, and we found a solution which has brought my skin under control for the first time In a year. A good GP surely won't mind being reminded of the guidelines.
I think Theredjellybean has basically given you them.
But really look at them yourself too. Because even if you are prescribed steroid cream, emollients and skin care are the absolute basis of eczema care and must be continued all the time whether or not the skin is broken (I recently did some research into this as part of my work, it's not the condition I have, but it's similar)

Watwing and FiguratelyDying - thankyou for your suggestions. Great idea about NICE guidelines. I will print them and take them with me to the GP.

After everyone's comments I have been moisturing the boys loads. We have gone through almost 500ml of diprobase in three days. Their skin definitely looks healthier and is a bit less itchy, but it is still very rashy, although the eczema patches do look slightly improved.

Going to ask GP for stronger steroid and patch test or blood test, though not too hopeful.

I am determined to get this under control/ get tothe bottom of it.

In the meantime, I am giving them lots of fish and avocados etc to help from the inside.

I would push for referral to specialist dermatologist or paediatric eczema clinic if you’re in London there are quite a few centres but 8-22 weeks waiting list. If they think allergy is part of the problem they will also refer to allergy specialist for usually skin prick testing. If your dcs eczema is still not under control after the GP after all this time they do need to see a specialist. Have a look at specialist dermatology or eczema centres around you, ring them up and check they are suitable for your dcs and how do your GP refer into them also check waiting list times. Most of them will have a nurse specialist who once you’ve seen the consultant can help with aftercare