To ask advice re.eczema patch that never seems to go away

[5lilducks]

Apologies-posting here for traffic.

My DD 2.5 has been having a patch of ezcema behind her knee that never seems to go away. She also has a patch on her hand. I keep trying different emollients spending £££s but nothing seems to work. I tried a new night cream and that seems to have cured the eczema on her hand but it doesn't seem to work on the one behind her knee. Gp has prescribed hydrocortisone cream and th ezcema behind her knee does get a little better with it but then comes back as soon as I stop applying it after 7days. The advice leaflet that comes with the cream says not to apply for more than 7 days as this could cause skin thinning? DD scratches esp.during night and that doesn't help. I cut her nails regularly to prevent further damage. For the last few weeks I have been wrapping her ezcema area with a bandage after putting emollient cream just to allow it to heal from all that scratching she does. She can scratch the top lay of skin off and it does my head in. My gp isn't any help apart from prescribing hydrocortisone. Has anyone experienced the same with their little ones and what worked ? also,have any of your little ones ever grown out of ezcema of this severity? None of my family have ezcema. DH used to have hayfever for many years since he was a child but it suddenly stopped when he was an adult and I developed hayfever about 6 years ago. Also, Dmil has both asthma and ezcema. This is stressing me out no end. Any advice will be greatly appreciated. Thanks

Have you been back to the GP? It sounds to me like it is responding to the steroid cream but it isn’t strong enough/a long enough course. They should be able to step up the treatment or refer to a dermatologist if they’re not comfortable starting stronger treatments.

Eczema is a pain the arse, what works for one person won’t necessarily work for another and you can invest a small fortune on collecting various potions trying to combat it or needlessly cutting whole food groups out of your diet (incidentally dairy does seem to be a quite common trigger in children). I think going to a dermatologist for some proper experienced advice at this stage would speed up you finding what works.

Thanks for your reply. I have been to the GP several times they keep prescribing the same cream. One gp told me to just keep applying it indefinitely and I don't have stop after 7 days but then she didn't say when I should stop. I don't want that cream to have any long term effects like skin thinning either. I have previously asked to be referred to a dermatologist and she said as it is a mild eczema they don't need to refer. Maybe I should see gp again.

My son has severe eczema, so I've been dealing with this for a loooooong time.
Current advice from dermatology is use the steroid cream for 7 days, or until the area is clear, then apply twice a week whether there's a flare or not.
Hydrocortisone is a really mild steroid cream, so I wouldn't be concerned about skin thinning with it.
Only use a tiny bit once a day, emollient on as much as you can, multiple times a day, and you should find it clears up and stays fairly clear.

You probably need a stronger steroid that will work when used short term. If the scratching is an issue have you looked at scratch sleeves? They are great.

Steroid creams need applying for a period of time after the top layers of skin have healed to allow the lower layers to heal.

If your child is responding to hydrocortisone then that's brilliant. It's the lowest strength steroid there is and anyone with anything above very very mild eczema will never respond to it.

They key is moisturising. If you don't moisturise very well very frequently then no amount of steroid will work. Apply moisturiser at least 3 times a day every day and wait about half an hour after applying the steroid before moisturising. Then when the skin is clear keep applying the steroid for 3-5 days but just once a day and keep up with moisturising every day.

Thanks for the replies so far. Much appreciated. @Whitelisbon I hope you don't mind me asking, are you using Hydrocortisone or a stronger cream ?

@acquiescence I have considered scratch sleeves but haven't got them yet as wasn't sure how DD will respond to them as she doesn't even like wearing gloves. Atm I cover the eczema area with bandage in the night after putting emollient cream. Sometimes in the night she will scratch and I then hold on to her hand to prevent her from scratching (we co-sleep) but then she starts scratching with her toes 🤷

@cookiemonster5 thank you for replying. Gp said she has mild eczema but even though the eczema gets a little bit better with hydrocortisone it never goes off completely . I suppose I should try applying it for longer than 7 days. I moisturise her eczema area more than 3 times a day but her whole body only once a day. Now I am wondering if I should moisiturise the whole body 3 times a day as well. I am also very confused about what gp means when she says "mild eczema" and I haven't found the answer on Google either. Not sure if it refers to the severity of any particular eczema patch or if it refers to how much the eczema has spread. I would have thought it refers to how bad any given eczema patch is?

@5lilducks

Thanks for the replies so far. Much appreciated. *@Whitelisbon* I hope you don't mind me asking, are you using Hydrocortisone or a stronger cream ?

@acquiescence I have considered scratch sleeves but haven't got them yet as wasn't sure how DD will respond to them as she doesn't even like wearing gloves. Atm I cover the eczema area with bandage in the night after putting emollient cream. Sometimes in the night she will scratch and I then hold on to her hand to prevent her from scratching (we co-sleep) but then she starts scratching with her toes 🤷

My son uses a selection of steroid creams, all stronger than hydrocortisone. Hydrocortisone does nothing for him, and hasn't for years.

Use the steroid cream for longer. It needs another week after it seems to have got better.

Use the steroid cream for longer. It needs another week after it seems to have got better.

I agree, and then use it twice a week on that patch to keep the skin clear. When my exzema was bad as a child my mum used to bandage my elbows at night, it really helped to stop scratching. The other thing was that I had to be careful what I wore, and knitted cardigans were the thing, so she sewed cotton hankies on the inside of the sleeves so they didn't rub.

Also, look at things like wahsing powder, fabric conditioner, soap, shampoo, are any of them triggering it?

Might be an idea to check what moisturiser you use - my sister used to have excema and found the E45 cream/lotion caused patches to get worse. Changed to something else (can't remember what) and it went away with HC cream

Oh and I am massively reactive to double base cream which is supposed to be all pure and basic. I'm OK with E45, but not amazing, Also can't use any form of nivea, but I can use all Body Shop creams9eg their cocoa butter), and Dove. So you do need to find the cream that works.

A lot of skin conditions severities are heavily weighted regarding how much of the skin they affect. When your GP is stating that it’s mild they are taking into account how much surface area is affected.

dermnetnz.org/topics/easi-score/

I think you’ve had some really good advice here on what to try with the steroid cream (hydrocortisone 1% cream can be bought over the counter if that makes things any easier) but it’s up to you how you feel about not following the direction of a doctor to the letter. If you are wavering then a dermatologist review would give you that reassurance.

I agree skin thinning isn’t really an issue so long as you’re careful to only apply it to the patches that need it.

Thanks for all the replies so far. I am using cetraben atm for all over her body as advised by GP. Maybe I should try something else now. For the last few weeks I have used Aveeno Dermexa night cream on the eczema patches only( too expensive to apply all over the body as it costs about £10 for about 75 ml) and it has worked a treat on the eczema on her hand. That said she scratched it this morning and it has got a bit worse, but it can be fixed I think. The one behind the knee is very stubborn so I think I will use the hydrocortisone for a little longer and see how it goes.

My child has had severe eczema all their life. Treatments are very individual. Definitely recommend scratch sleeves and the bandaging. We use epaderm ointment as emollient - cetraben stings, as does epaderm cream. We use elocon or dermovate as standard as their skin doesn't even notice hydrocortisone. Consultant advice is to use it until the skin heals, plus a couple of days. Hit it hard and get it under control. Behind the knees is hard - and it sounds as though you have it in the family - asthma, hayfever, eczema all linked to genes. Good luck. Eczema is so hard!

Hello. Lifelong eczema sufferer here. Please do be careful of over using topical steroid- I have used steroid my whole life and I have had skin thinning to the point that my skin can no longer be controlled by it. This is called Topical Steroid Withdrawal and it is hell.
My suggestion would be try sunbathing the affected area when you can, 10-15 mins a day pulling the trousers up in the park/ garden/ near the window. This is all I got my son’s eczema under control long term. I have experience in phototherapy myself as well, but find natural sun-ray more effective. Also try different moisturisers- what suits me doesnt suit my son. Sudocrem is good for itch/ raw patch/ wound. Vaseline good for giving flexibility but not fast absorbing. Almond oil/ sunflower oil is good for large area application and natural. Aveeno is light, Neutrogena a bit thicker. Always patch test new products. When itchy say “rub rub” instead of scratch to ease some of the itch. File nails daily if need be. Short warm bath, not hot.

Forgot to add- make sure not to use certain products before sunbathing, or the skin will get burnt. Oils obviously, and also Vaseline/ petrolium based products.

Bandages on mine make me want to scream because the sweatiness in the crease of my arm, covered by a bandage is horrible.

I sometimes have to taken antihistamines for mine when the itch is too bad.

I echo others - e45 and other creams have made mine worse. The bath stuff is helpful.

Keep applying the cream. Is it the 0.5% one?

You could try the hydrocortisone as an ointment rather than cream, I find that works a bit better (I prefer all my steroid creams as ointments actually). You should also probably have a chat with the GP, one of mine had a dry/eczemitous patch that wasn’t really going away - we were given a chlorhexidine wash (like you would use before an operation) and that cleared it up. Likewise if there were a fungal cause something like daktacort might work.

My kids have the exact same problem. Hydrocortisone for 2-3 days usually works and twice a day (or 3 times) nivea soft. Keep up the nivea soft afterwards once a day and it should clear. For us, nivea soft is the only cream that works and doesn’t make it worse.

Have you tried Childs farm baby moisturiser? Its really soothes my eczema on my eye lids. I know I'm an adult i don't like to use steroid cream on already thin skin.

Also have you considered a milk allergy? Is DC phlegmy or has diarrhea regularly? I know its anecdotal but my friends DC had really bad eczema until they did an allergy test then cut it out.

I had absolutely terrible eczema as a kid, bad enough to need hospital visits every couple of weeks when I was the same age as your DD.

I also scratched until I bled and my mum sewed mittens and socks into my pyjamas to stop me scratching in my sleep (with both fingers and toes). Vaseline worked fairly well as well as oilatum in the bath. I'm fairly sure I was also given steroid cream but couldn't tell you what strength.

The good news is that I did grow out of it - or at least to a very manageable level. By the time I was out of reception it was clearing up and continued to get better throughout primary school.

I still have patches that can get bad if I don't treat them (behind the knees, insides of elbows and back of underarms), but in my early 20s I discovered first an oat based cream from lush and then Aveeno (also oat based), and so long as I use that daily when I get out of the shower on the problem areas, I don't get any flair-ups - even if I'm using a harsh shower gel or a fancy shampoo. Personally I use the green one, which you can often pick up on deal from Boots or cheaper than average from Wilkos / Savers for under £4 for 200ml. A little goes quite a long way as well.

I've also had other friends say that their eczema has really been helped with anything oat based.

Good luck with your DD!

*as did oilatum in the bath

I'm not recommending using vaseline as a bath oil!

Have you tried dietary change-ups?

Thank you all so very much for your replies so far. They have been very helpful. Sorry I haven't been able to respond to the replies after my last post. Have been constantly trying to keep dd's eczema under control. At the moment her eczema seems to be under control after applying HC and cetraben. I think if and when it flares up I will try some other creams as well. Sometime back I applied Aveeno Dermexa night cream and it seemed to have sorted her eczema on her hand but I think it made it worse after a few days and I wound up having to apply HC on her hand too . To the poster who asked about dietary changes , I have noticed that eggs seem to make dd's eczema worse so I have cut it out of her diet. I don't really want to cut milk out unless I really have to tbh as mil has Osteoporosis and I worry if DD will not be getting enough calcium. She is a fussy eater so I think I will struggle to give her alternatives to ensure she has sufficient calcium. I spoke to gp again and they said it is normal and to keep moisturising and that she should grow out of it later. Quite dismissive. I will try the different suggestions on here when her eczema flares up again.