Help please! Cannot get skin condition under control (pics)

[Claw001]

I’ve posted about my son before.

Just before Christmas my son (14) had some kind of severe reaction on his face. GP thought allergy. Anti allergy tablets didn’t help, it got much worse and also spread.

Back to GP who gave steroid tablets, steroid cream, antibiotics and anti allergy. It cleared, for 7 days, until the day after steroid cream stopped, flared back up again and got worse.

Back to GP, said no more steroids. Gave moisturiser and anti allergy tablets. It got much worse.

Back to GP, who gave steroid cream, antibiotics, anti allergy, told me not to use moisturiser, as son had allergic reaction to it. Nothing cleared it this time. Referred to Dermatologist.

Dermatologist today, has said eczema, definitely no more steroid cream, as it’s making it worse. He has prescribed steroid tablets for 5 days, a different moisturiser and anti allergy. Come back in a month. I told him the minute the steroids stop, it flares back up again and gets much worse each time and moisturiser doesn’t work or just aggravates it. He has ignored.

What can I do?

Maybe the steroid tablets will have a different effect to the cream as they are acting from the inside and far more powerful? The problem you have is that steroid creams are the main way to clear eczema but they are not suitable for long term use on the face.
I'd try what the dermatologist suggested as he is the expert.

My GP prescribed steroid tablets previously. It clears on about day 3. Stays clear for the next 2 days. Day 6, immediately after steroid tablets stop, it flares straight back up again.

Have you tried any of the creams like Moo Goo or Aveeno

Does he swim?

Oh that looks very sore! The shoulder pic def looks like eczema. The others not so much but there are lots of different types of eczema so I would trust the dermatologist. If you aren't sure the diagnosis is correct you could also ask for a second opinion

The previous poster is right in that you don't want to use steroid creams for long especially on the face as they thin the skin.

Does he put anything on it at all? I have rubbish skin. Very sensitive to everything and I have two types of eczema (not on my face) and rosacea (obvs on my face).

I find tropics products amazing for the skin. I use their cleanser toner moisturiser but their tamanu balm has pretty much cleared up the eczema on my hands. I also use it at the first sign of any rosacea on my face and it also clears that up. Haven't had to use antibiotic cream for ages.

I would also try cutting things out if his diet. I would try dairy first and then grains. You should now after a couple of weeks if it's going to do anything. You could also try other allergens.

I have just started an anti inflammatory diet which is essentially eating very healthily! So limiting refined sugar, fat, red meat, processed meat, processed food. Eating lots of fruit veg whole grains plus fish and white meat. Might be worth a try if cutting out allergens doesn't work.

Above diet should improve gut bacteria but maybe an idea to do other things to improve microbiome such as taking probiotics, eating stewed apple with cinnamon (no sugar). Limiting sugar and processed foods. Eating rainbow foods (ie lots of colours). Lots of different fruit and veg. Eating fermented foods.

Good luck. Skin conditions are horrible.

I second the suggestion of considering food intolerance.

Would you consider cutting dairy for a while to see if it helps

We have tried epimax and dermitol (soap replacement and moisturiser) E45, coconut oil, adex gel and dayleave gel.

The difficult is, they don’t prevent or improve a flare up. During a flare up, any moisturiser aggravates the skin and makes it worse. A flare up happens, the minute steroids stop. A vicious circle.

I’ve made a note of the creams and will give them a try. Thanks.

www.purepotions.co.uk

We went through lots and lots and lots of creams & steroid creams etc from the doctor for our ds, Nothing really worked.

Until we came across skin salvation cream from pure potions. It worked. Ds had full body break outs, constant itching and red patchy skin all over and now it's is all clear.

Worth a try 😏

If it is eczema, it will continue to flare up if you do not maintain the skin. If you have a bath, put oats in a sock and let hot water pass through the oats into the bath and let your teen have a good soak in it. This will calm the irritation, stop using soap and invest in a good emollient like Aveeno (intensive one) or Eucerin 10% Urea, which do need to be applied twice a day until things go back to normal and you can reduceto once a day. This won’t resolve on a day, it may take a few weeks.

I found out my son eczema was made worse by aqueous cream and other cheap tubs of moisturiser prescribed by the GP, so if what was prescribed didn’t help try the above.

You may also want to look at their diet (too much dairy can make it worse), wash bedlinen every few days with hot water (or dry on the wash line or with a dryer to kill mites), He may have also got suddenly allergic to a family pet (my son gets hives with certain breeds of cats and dogs (short haired by shedders So keep the pets away of any textiles your son uses for the time being.

Oh, and very important, stress also exacerbates eczema so just check he is not loosin sleep over something like exams, strained friendships, etc.

I would suggest you try to get another appointment to get more steroids if the flare ups continue.

He doesn’t swim.

He has Autism. His diet is extremely limited. He doesn’t eat dairy. He eats exactly the same thing everyday and has done for years.

Breakfast toast (no butter) juice.

Lunch croissant (plain) grapes, crisps, juice.

Dinner chips, salad and he alternates bacon, chicken nuggets, garlic bread to go with his chips and salad.

Snacks crisps and occasional certain biscuits.

(Working with OT for years to try and improve on this)

He was recently referred to Paed for long standing (since age 5) fatigue (which is thought to be anxiety related) he has regular blood tests. Latest showed thyroid and Vit D, were within normal range, but ‘a bit on the low side’. He takes Vit D and B12 supplements.

Have you changed any brands of food or even the ones of the vitamins and supplements? Has the packaging changed? Some times the product changes and things like this happen.

Ps. Most tablets contain lactose, so check medicines too.

My sympathies, OP, that skin looks very inflamed and sore, it must be hard to cope with.

I've suffered bouts of eczema from childhood and still struggle with it sometimes now, decades later, so I've a lot of experience and some thoughts to share.

Firstly, did you ever discover the cause of the initial flare up? If you haven't then maybe he is still coming into contact with that substance, so please rack your brains to find the triggering substance/food. If the face flared first, did he try a new face cream/shaving product/other toiletries around Christmas - perhaps he received a "smellies" gift? Or did you try a new laundry wash/conditioner? Some of these products are notorious for causing skin reactions, especially biological laundry products. Modern washing machines often use minimal amounts of water to rinse, so traces of the products can remain and lying on a pillowcase that is loaded with laundry chemicals can cause a reaction for side/front sleepers.

Things I do to minimise flare ups: avoid perfumed skin/hair products, animals (allergic), dusty places, highly spiced food (spices come out through sweat glands), use less than the recommended amount of laundry liquid (or none - laundry balls) and don't use fabric conditioner (not necessary and not worth risk). Moisturise with Aveeno cream - much better than many products GPs prescribe.

If GP prescribes ointment, the base is usually white soft paraffin/AKA vaseline, which is cheap but can sometimes overheat sensitive skin (it's useful as a barrier for handcream but not great for face, I find). So ask for the cream, not the ointment version, because otherwise they will prescribe ointment as it's cheaper.

Too much chocolate/sugary foods can also aggravate my skin. Maybe that was a factor, over Christmas?

I use Piriton (or cheaper unbranded version - cetirizine hydrochloride (sp?)) to help calm skin at night, and change pillowcases frequently (face very sensitive).

Good luck OP, it's a tricky thing to manage. If you post again with further details/thoughts I will try my best to come up with some useful ideas. Products that are perfect for one person can cause reactions for another, so it's all trial and error.

Any chance of there being a fungal element to it?

No, I can never switch brands! He knows the difference and will refuse to eat!

Vits etc are the same too.

I’m wondering if he has developed an intolerance to something he was previously tolerant of.

One day he was fine, he went to bed without a thing on his face, woke up next day with his face absolutely smothered. He now has it all over his shoulders, arms, back and on one hand too. Nothing on his bottom half.

Push for a referral for allergy testing.

My skin looked almost exactly like that, and the dermatologist referred me for patch testing. I had a grid of over 100 patches of allergens taped to my back on Day 1, removed and observed on Day 3, observed again on Day 5. Also some skin prick tests. Patch tests showed clear contact allergy to specific things, whereas skin prick tests showed no significant histamine-type allergies. I immediately started eliminating the allergens from my household.

IIRC I was on a low dose of antibiotics for about 6m, plus pimecrolimus and hydrocortisone ointments as needed for a year or more.

Pretty much all the traditional, bland emollients irritated my skin, even the prescription ones. The absolute best moisturiser I found, the only thing my skin can tolerate when it is reacting, is pure, cold pressed virgin coconut oil used very stingily. Also making sure that all treatments are greasy ointments, not water-based creams or lotions.

It took several months for me to get relief from my symptoms, and about a year for my skin to fully heal.

Have you tried clarithromycin?

Is also could be fungal... or scabies! Google images look very similar -I think it's easy to treat with a lotion... worth a try?!

Silk pillowcases were much more comfortable to sleep on when my face was inflamed. I bought a pair, but dh didn't get to use the other! One in the wash, one in use by me. Washed them in Liquid Soap Flakes, no fabric conditioner. They do need ironing, unfortunately, to ensure their softness against the skin.

What did the doctor mean by his thyroid and vitamin D being in the low side. Have you got the actual results? Thyroid issues can cause fatigue and skin conditions.

How low was his vitamin D and how much is he taking as a supplement? Have you had him retested to check the supplement is working?

As his diet is so limited have other vitamin deficiencies been explored?

Gut bacteria could also be an issue with such a poor diet. If you can improve his diet perhaps add in a good quality probiotic. You may have to try a few to find the right one.

No, never discovered the cause. It first flared on Christmas Eve. He has Autism, his diet is extremely limited and exactly the same every single day. His routine and diet is very rigid and never changes. He doesn’t eat chocolate or sweet things (occasional biscuit, however always the same type and brand!)

He never puts anything on his skin, he cannot stand it. He showers, never bathes, has never used soap (cannot stand the feel on his skin!) just water. In fact he even hates water on his skin! No deodorant etc. He doesn’t shave as such, only has a little tash! He uses an electric shaver on his top lip.

He takes Loratadane tablet during the day (non drowsy) to stop the itch and Piroton of a night (drowsy to try and help sleep) on advice of GP. Neither stop the itch.

He is often kept awake at night or it wakes him up. It’s causing him a lot of anxiety on top of his usual anxiety, in school others are commenting on his appearance.

It definitely looks as if something is irritating his skin. I just can’t think of what it can possibly be.

We have always had pets. A dog and 2 cats. He doesn’t allow them in his room (where he spends most of his time) we don’t have any carpets anywhere in the house, even the stairs. All wooden or tiled.

I agree with MiniMum97 I was just watching the latest episode of iview.abc.net.au/show/catalyst on allergies and the immunologist was describing a current clinical trial at Westmead hospital in Sydney for kids with allergies and related conditions such as asthma and eczema with probiotics and specific gut friendly fibre.
So a good quality probiotic might be a good idea, especially after the courses of antibiotics he has had

mini I took him to my GP with severe fatigue. GP ordered full blood count. Came back thyroid needed retesting in 6 weeks. Tested again, came back the same. Retesting in 6 months. Couldn’t get a straight answer from GP ‘it’s fine, but on the low side’ which is it!! Fine or low! asked for a referral.

Paed has written ‘blood test showed a borderline elevated TSH of 4.77. This is within normal limits’

Doesn’t mention the Vit D result. Just within normal limits, but lower side of normal. So prescribed Vit D supplement.

He had several blood tests, full blood count, urea and electrolytes, ferritin, b12, Vit D and thyroid function test.

In October paed retested, I phoned for results. Secretary told me ‘all fine’ and was discharged.

Paed then asked my GP to continue with Vit D, due to diet as a precaution.

Havent tried clarithromycin

The 3rd picture does look a bit fungal. This was the skin, once steroids were stopped and all I used was Epimax and anti allergy tablets. My GP said he had an allergic reaction to Epimax, which is why skin is so red.

The other 2 pictures are how his skins looks with steroid cream, antibiotics, anti allergy tablets and using moisturiser.

His skin has only been totally clear when he was taking steroid tablets, steroid cream, antibiotics, anti allergy and moisturiser, all at the same time!

Do you remember how everything started? It was just before Christmas but where on his body did it start and how did it look like at first.

It seems there was a cascade of reactions.