Toddler eczema - contradictory guidance?!

[JustLurk1ng]

Aargh. So my son - 18 months - has had eczema since 5 months old. It was really bad but we got on top of it (mostly) by initially using topical steroid creams prescribed. Then cutting out foods we discovered he was allergic to, switching washing powders, and moisturising regularly.

Went to see dermatologist at 12 months and her view was - shouldn't use steroids, keep on top of things with moisturising and keep doing what you've been doing. Steroids shouldn't be overused in babies etc etc.

Then today my husband took my son to see dermatologist (different one). Who basically said you're not keeping on top of it (it's almost exactly the same as it was 6 months ago), gave him a massive guilt trip and prescribed potent steroid cream for an initial course of 7 days... then weekend use for an undefined period.

I'm not one of those people who thinks I'm better than the experts - but how do I reconcile these apparently contradictory sets of guidance?

Anyone who has a young one with eczema using (or not using) steroid creams who can provide me with reassurance or their experience?

DS has it on his wrists fairly badly and patches on his legs. It's a bit flarey at the mo because of the hot weather. He scratches a bit when he's grumpy or in pain usually, but doesn't seem to cause him discomfort or stop him sleeping that I can tell.

You may not actually be getting contradictory advice. You should not be using steroids as your only treatment, that is true. Emollients are the answer to maintenance. However, steroids SHOULD be used briefly for acute flare-ups. You may need to experiment a great deal until you find the moisturisers that work for you, Some children do not tolerate some ingredients. Bath emollients have recently been found ineffective. Creams need to be applied 6 times a day, that's a lot of greasing

My dd3 has been bad with eczema since the same age. We finally got referred to a dermatologist this year and her eczema has pretty much cleared up since we started a rather hardcore regime of steroids. We also have various emollients to use as maintenance.

Thanks confused... we experimented with loads of creams and found one that seems to work really well (expensive though). I guess I'm just puzzled that although the skin is almost exactly the same as the last visit we've gone from 'just moisturise' to full on steroid use.

The last appointment I felt bad for using steroids... now I feel bad for not using them. Got to laugh (or cry)

Thanks Morris. Do you still use steroids and how often? Are you glad you did it?

Yes I'm very glad I used them. My GP was very reluctant to prescribe them but the dermatologist seemed annoyed that we hadn't been using them much given how long dd has been suffering. Our GP prescribed a mild one once and said to only use for 3 days very thinly applied. Dermatologist prescribed a stronger one said to use for at least 7 days, then basically take a view as to whether it was helping. If it was helping, but eczema was still present, then continue for another 3 days and the reasses again (the aim being to use no longer than 14 days). We ended up using it for 10 days (in combination with a new emollient) and it pretty much went. We had two different steroid creams for different parts of the body and have also been prescribed a non-steroid cream to use when the flare ups aren't so severe.

However, I should add that weather is definitely a factor with dds eczema so there is a possibility it may have improved anyway given the warmer weather but it did flare up a week or so ago when we had a few days of the temperature at 30 odd degree which I expect was due to dd being so sweaty. I used the steroids again for 2 days and it cleared up.

Our dermatologist explained that the difficulty with eczema is that what helps one person (like child's farm/aveeno - made no difference to my dd) won't work for another person so there is a lot of trial and error and no real solution but dds skin is great at the moment, I'm quite worried about when the weather changes .

I should add that there are some very experienced specialist nurses around if you can find one. I met one who was brilliant. Had worked in dermatology for years

I found that once a flare up had taken hold it was impossible to resolve it with just emollient. Steroids were miraculous-cleared my son’s whole back and tummy in about 48 hours. We were told to be reasonably sparing with the application-we just covered it rather than slapping it on as you would sun cream or emollient. Also told to use it for the time specified even after it had reduced.

It isn't that straightforward. Agree with pp that once a flare up takes hold only steroid will work. The best advice I got was to use steroid at the first sign of flare up. And continue to use until completely clear. By doing this I was at first using much more steroid BUT the gaps between flare ups became much longer. Both my dc have eczema. I've tried to attach a photo of a book I found very useful also.

Oh and emollient Lots of emollient. Even when skin seems clear.

Given the side effects I don’t use steroids on my kids eczema no matter what the dermatologist says, unless they are scratching badly at night.
I’ve found oats In the bath tied in an old sock to be fantastic emollient, and colloidal oat cream.
Dermatology is such an odd discipline ,with a low job satisfaction quota. When I was a nurse we used to call it the hit and miss clinic.

I'm going back a very long time, but when my DD was 18 months old (now 16) she had terrible eczema. I was given emollients, but no steroids and told that if I could control it before she was 2, there was a good chance that she would grow out of it. It seems like bonkers advice now, reading it back, but it worked. I used Oilatum regularly, but the biggest difference was switching to unperfumed washing liquid and fabric conditioner. We all switched, including grans, to Surcare ( not sure if it's still available) and her eczema literally just disappeared quite quickly. She hasn't had a problem with her skin since. I use non bio washing liquid now and any old fabric conditioner and it has never reappeared.

My sons eczema was head to toe, weeping and pussing. The only way to get under control was oral steroids, then we slowly reduced the amount through ointments. We now only need cream for flare ups. Our son is so much happier and his skin is mainly clear (ankles, wrists and then sometimes flares on legs and tummy/back). Like you we have since been diagnosed with allergies and so that has also had a huge impact. The main difference is his happiness and that has been wonderful.

Thank you all! This is really reassuring and keeping my fingers crossed that the steroids will clear the eczema on his wrists for good!

And thanks for the book recommendation nails... free with kindle unlimited. Bonus!